A N A PPR OAC H T O CH E ST A N D A BD O M I N A L T RA U M A

A P R ES EN TAT I ON BY TH E C AS UA LT Y C R EW

F L A I L C H E ST

• OCCURS WHEN SEGMENT OF FRACTURED RIBS ARE SEPARATED FROM THE CHEST WALL

• NOTE THE PARADOXICAL MOVEMENT• MAIN AIM OF TX IN CASUALTY IS PAIN

CONTROL AND ICD• PAIN CONTROL VIA INTERCOSTAL

NERVE BLOCK• SURGEONS AND ICU MUST BE

INVOLVED EARLY, OFTEN PTS REQUIRE VENTILATION

• OFTEN THERE ARE ASSOCIATED LUNG CONTUSIONS, HAEMOPNEUMOTHORAX AND CARDIAC CONTUSIONS

F I ND THE FL A I L S EGMENT

LE T S T RY A N XRAY

LO O K C A R E F U LLYLE T S T RY O NE MO R E

CLAVICLE #

ROTATION OF RIBS

V ERY S U B T L EL A S T O NE

W H AT I S T H E D X ?PT W I T H SE V ER E A ST HMA

TE NS I O N PNE U M O T H O RA X

• NOTE THE TRACHEAL DEVIATION

• ABSENCE OF LUNG MARKINGS LEFT

• DEEP SULCUS SIGN LEFT

W H AT S T H E D X ?PT W I T H A STA B T O LE FT CH ES T WAL L

A N E A S Y P N E U M O T H O RA X T O S E E

T HAT S R IG HT

H E M OT H O RA X F F G S TA B

AL S O A N E A S Y O NE

S A F E Z O N E FO R I C DVE RY I MP O RTANT

S I G N S O F STA B H E A RT

• DISTENDED NECK VEINS AS SEEN HERE

• MUFFLED HEART SOUNDS• LOW BP• CALLED BECKS TRIAD• EVEN ONE OF THESE

SHOULD AROUSE SUSPICION OF STAB INTO HEART

HOP EF ULLY YOU WI L L S E E ONE S OM ET I M ENOT P ER FORM ED R OUT IN ELY I N O UR CAS U ALT Y

EME R GE NCY T HO RACO T O MY

ME A N S F R EE A IR I N P E R I T O N EA LC AV I T Y

FR E E A I R U NDER D I AP HRAGM

WH AT I S T H I S C AL L E D WH AT D OE S I T IN D I C AT E

CH I LD FE L L A ND I N J UR E D A BDO ME N

DO U B LE WA L L S I G N

• AIR IS PRESENT ON BOTH SIDES OF THE INTESTINAL WALL

• INDICATES FREE AIR IN THE PERITONEAL CAVITY

W H AT I S T H I S C A L L E DINFA NT W I T H SP ON TA NE O US ONS E T PA I N A ND PE R I T ON I T I S

F O O T BA L L S I G N

• ALSO A SIGN OF FREE AIR IN THE PERITONEAL CAVITY

C AN YO U S E E T HE F O O TB AL L AN D THE DO UB L E WA L L

SU P I NE V I EW

TRA U M A TO T H E A BD O M E N

• PERITONITIS IS MUCH EASIER TO ELICIT IN ADULTS

• MOST INTERNS AND JUNIOR MO’S CAN IDENTIFY OR HAVE A HIGH INDEX OF SUSPICION FOR IT

• MUCH MORE DIFFICULT IN CHILDREN ,TODDLERS AND INFANTS

• ANY CHILD WITH ANY TRAUMA TO ANY PART OF THE BODY MUST STILL HAVE THEIR ABDOMEN CHECKED, ANY SUSPICION OF INJURY SHOULD MEAN THEY HAVE AN X-RAY DONE

OFT E N A S S O C I AT E D W I T H IN T RA B DO M IN A L A N D S P I N A L I N JU RY

SE AT BE LT IN J URY

V ERY C O MM O N W IT H S EAT B ELTIN J U RY

CHA NCE F RACT U R E S

CHANCE FRACTURE CT

G R EY-T UR NE R& CU L L EN S I G N

• SIGN OF RETROPERITONEAL HAEMORRHAGE

• SEEN IN TRAUMA, HAEMORRHAGIC PANCREATITIS, LEAKING AORTIC ANEURYSM, RUPTURED ECTOPIC PREGNANCY