Primary Survey Circulation Cardiac tamponade- what happens? Beck’s triad? Pulsus paradoxus: decrease in SBP >10 during inspiration Immediate dx and tx: pericardiocentesis vs ultrasound. Will require thoracotomy.
Secondary Survey Includes all xrays, ABGs, FAST, labs, etc. Should have definitive airway at this point and IV’s. Looking for areas of bleeding in closed cavities, fractures, etc.
Secondary Survey: Thoracic Simple pneumothorax May discover on chest x-ray
Secondary Survey Pulmonary contusion: persistent hypoxia Tracheobronchial tree injury: hemoptysis, subcutaneous emphysema, tension pneumo Blunt cardiac injury: may show ECG abnormalities, at risk for dysrhythmias. Aortic rupture Traumatic diaphragmatic injury.
Other Manifestations of Chest Injuries Subcutaneous emphysema: probably will need chest tube, especially if intubating. Rib, sternum, Scapular fx: severe injuries, think about trauma to underlying organs and vessels, spinal injury. Esophageal trauma: gastric contents empty into thoracic cavity. Will require thoracotomy and repair.