3 pathophysiological factors of Thoracic trauma are Hypoxia, Hypercarbia, Acidosis

Best inv for chest injury is Chest X ray

2 Signs to rule out Pneumothorax in USG chest 1) Lung Sliding Sign 2) Comet tail arteact
Tube thoracostomy inserted in 5th/6th ICS (Triangle of Safety)
Indication for thoracostomy tube removal a)Absence of air leak b)Less than 100ml fluid drainage
Indications of Emergency thoracotomy
a)Cardiac arrest(resuscitative
b)Massive hemothorax >1500m stat / >300ml/hr
c) Penetrating inj of chest with cardiac tamponade
d)Large open wounds of thoracic cage
e)Major thoracic vascular injuries with hemodynamic instability
f)Major tracheobronchial injuries
g) Esophageal perforation
Most imp part of management of rib# is Pain management
Flail chest Presence of 2/more # in 3 or more consecutive ribs causing chestwall instability
Mc associated wound with flial chest Closed head inj
Mc cause of death at scene is Tracheobronchial injuries
Arrhythmias common with blunt heart inj RBBB
Beck triad in cardiac tamponade Muffled heart sounds, Distended neck veins, Hypotension
Esphageal injuries has pain out of proportion to clinical findings, pleural effusion without rib#
Treatment of Espohageal injury is early debridement & repair <24hrs
>24hrs cervical esophagostomy and distal feeding access
Unstable blunt trauma inv DPL, FAST
Stable blunt abd trauma inv USG, CT
Very sensitive test for abd inj is Diagnostic peritoneal lavage
Indications of DPL
Equivocal pulm embolism
Unexplained shock/Hypotension
Altered sensorium
GA for extraabd procedures
Cord inj
Std criteria for positive test in DPL
Aspiration of 10ml gross blood
Bloody lavage effluent
RBC >1,00,000/mm3
WBC >500/mm3
Amylase >175 IU/dl
Detection of blood, bile, food fiber
FAST- Focussed Abdominal Sonography for Trauma main purpose is to document free fluid in
abdomen. Seeing solic organs done but not primary aim
CI for DPL Clear indication of exploratory laparotomy

Gastric and duodenal inj are mostly due to penetrating injuries, Blunt injuries rare
Dx of gastric inj by blood in NG tube aspirate
Rx is debridement and primary closure in layers
Mc blunt trauma ass with duodenal inj Steering wheel inj
Xray duodenal injuries
Mild scoliosis
Obliterated right psoas
Absent air in duodenal bulb
Air in retroperitoneum outlining kidney
Leak of gastrograffin is definitive indication for Exploration
Coil spring appearance & Stacked coin sign seen in Duodenal hematoma
Duodenal hematoma not an indication for surgery
CECT findings of duodenal inj Retroperitoneal air
Rx og grade 1 2 duodenal inj Simple primary closure
Rx of grade 3 Primary repair, pyloric exclusion & exclusion, roux-en-Y duodenojejunostomy
Rx of grade 4 Primary repair of duodenum + CBD repair
Rx of grade 5 Pancreatico duodenectomy
Cycle handle inj Mc mode of inj of : Pancreas
Pancreas inj has signs more than symptoms
Urine/serum amylase levels not diagnostic, Widened C loop of duodenum, DPL is not suggestive
Mc inj after penetration & blunt trauma Liver
Colon is 2nd Mc inj in gunshot & 3rd after stab inj
If bleeding stops after Pringels maneuver Culprit is Portal vein/Hepatic artery
If bleeding continues after pringel maneuver Source is hepatic vein
Warm ischemia time of liver 1hr
Superficial penetrating renal inj Primary closure
Deep penetrating renal injuries Partial/Total nephrectomy
Extraperitoneal bladder injuries Rx conservatively by Foleys for 2weeks
Intraperitoneal bladder injuries occurs at dome of bladder. Rx by primary repair and
SPC(transabdominal approach)
Posterior urethral injuries associated with Pelvic #
Anterior urethral injuries associated with Straddle #
Grade 1 ACS 12-15mmHg
Grade 2 ACS 16-20mmHg
Grade 3 ACS 21-25mmHg
Grade 4 ACS >25mmHg
ACS causes both Metabolic and Respiratory acidosis