ECMO-/ECLS

contusions, or lacerations are noted as visual surveillance is carried down the
chest for obvious signs of external injury. In addition, the chest wall motion is
observed for asymmetric chest rise or paradoxical movement with respirations.
The exam should then proceed with auscultation of the chest for symmetrical,
bilateral breath sounds. Absent or decreased breath sounds are suggestive of
a hemothorax or pneumothorax and immediate drainage with tube
thoracostomy is indicated if the patient has cardiopulmonary instability.
Auscultation is followed by palpation of the neck, clavicles, sternum, and chest
wall to assess for any tenderness, skeletal instability, or crepitance. Finally,
percussion of the chest for dullness or hyperresonance completes the chest
examination. Abnormalities in the chest exam should prompt further
investigation with radiological studies for intrathoracic injuries.
For penetrating injuries, particular attention should be directed to Zone I
of the neck, which is bordered by the cricoid cartilage superiorly and the
clavicles inferiorly. This location is the thoracic outlet and is densely occupied
by significant structures that may be potentially injured, including the carotid
artery, internal jugular vein, trachea, and esophagus. As visual inspection
descends down the chest, the number, location, and character of open wounds
should be noted. Sucking chest wounds should be addressed immediately with
a three-sided dressing to prevent precipitation of a tension pneumothorax. In
cases of missile injury, the wounds should be marked with a radiopaque
marker, prior to chest X-ray. The chest is then auscultated bilaterally to assess
for symmetric breath sounds. Lastly, the neck and chest are palpated for