A. Physical Exam
- Primary Survey
The initial evaluation of a child sustaining thoracic trauma begins with a
primary survey, prioritizing airway, breathing, and circulation. A child who has
the capacity to cry or speak demonstrates an intact airway. In cases where the
airway is questionable or the patient has altered mental status, maintenance of
a patent airway can be achieved by repositioning the head with a chin lift and
jaw thrust to move the mandible anteriorly. Suction and oral airways are also
useful adjuncts to ensure airway clearance. Ventilation can then be achieved
by bag-valve masking the patient. In patients with severe head injury,
unresponsiveness, or hemodynamic instability, endotracheal intubation with in-
line cervical spine stabilization is indicated. Once the airway is secure, breath
sounds should be evaluated bilaterally to ensure adequate air movement and
ventilation. Intravenous access, hemodynamic monitoring, and resuscitation
occur simultaneously as the patient is evaluated for life-threatening injuries that
may require immediate intervention.
B. Examination for chest injury
The chest examination in blunt injury should be approached
systematically to ensure injuries are adequately identified. An efficient physical
exam begins with a quick visual inspection of the neck and chest in the
cephalad to caudad direction. The trachea is checked for midline position and
the internal jugular veins are inspected for distention. Any abrasions,