Trauma of CHEST

CHEST TRAUMA MI Zucker, MD A dr Z Lecture • On Major Chest Trauma • In Three Parts Chest trauma • Blunt • Penetrating • Explosion Related Chemical Agent Related Biological Agent Related Oh, yeah: There’s a separate lecture on Traumatic Aortic Injury But first: A few comments on Trauma Imaging Trauma Chest Radiograph • Usually AP, often supine, frequently in poor inspiration • So, a challenge to interpret CT Chest More sensitive and specific CT Chest: Reformat • The new MDCT scanners awesome reformats without additional scanning Part the First: BLUNT TRAUMA Fractures and Dislocations • • • • • Spine Ribs Clavicles Sternum Shoulders EXPLOSION: Flying glass CHEMICAL AGENTS Accidental/Terrorist CHEMICAL AGENTS • • • • Nerve agents: Sarin, soman, tabun, XV Blister agents: Lewisite, mustards Choking agents: Chlorine, phosgene Blood agents: Cyanides CHEMICAL AGENTS • Nerve agents inactivate acetylcholinesterase • Blister and Choking agents cause acute airway and lung injury • Blood agents inactivate cytochrome oxidase causing cell hypoxia NERVE AGENTS: Aspiration CHOKING/BLISTER AGENTS: Acute Lung Injury BIOLOGICAL AGENTS Accidental/terrorist BIOLOGICAL AGENTS • • • • • Inhalational Anthrax Plague Tularemia Viral hemorrhagic fevers Ricin To be effective, agents must be aerosolized INHALATIONAL ANTHRAX • Necrotizing hemorrhagic mediastinitis PLAGUE: Bilateral pneumonia TULAREMIA • Pneumonia with lymphadenopathy VHFs • Bleeding into lung parenchyma RICIN • Biological toxin from castor bean • Inhibits protein synthesis • Causes pulmonary edema/ARDS People who liked this lecture also liked: “TRAUMATIC AORTIC INJURY” Available from your local Emergency Radiology lecturer now! But for now, GOODBYE • Copyright 2004 MI Zucker ... comments on Trauma Imaging Trauma Chest Radiograph • Usually AP, often supine, frequently in poor inspiration • So, a challenge to interpret CT Chest More sensitive and specific CT Chest: Reformat... On Major Chest Trauma • In Three Parts Chest trauma • Blunt • Penetrating • Explosion Related Chemical Agent Related Biological Agent Related Oh, yeah: There’s a separate lecture on Traumatic... Rib Fractures • In themselves, not too much of a problem, but may be an indicator of underlying pleura, lung, liver, spleen, kidney injuries Flail Chest • Multiple rib fractures, especially if