Muhamad Na'im B Ab Razak (jacknaim) is a fresh graduate Muslim Doctor from Universiti Sains Malaysia and waiting for the enrollment into the housemanship program. Ambitious in pursuing master program in emergency and traumatology medicine and loves to spent his free time joining humanitarian missions, writing and speaks as an amateur public speaker in motivation and comparative religion. [HOME]

Blunt Injury to the Chest


Answer

1) The picture shows a young man
- wearing a cervical collar
- Cardiac monitoring attach to the chest
- BP cuff on the right arm
- Presence of steering mark on the right chest and other bruises on the left chest.


2) Eye (2), Verbal (4), motor (5). Total (11)


3) injuries that likely to occur in this patient
a) Head injury (the head strikes the windscreen)
b) Neck injury (the next is hyperextended during the mechanism of injury
c) Injury to mediastinum
- Fracture sternum and ribs
- Rupture of heart, aorta, main bronchus, esophagus


4) Investigation

a) Blood investigation
- FBC, RFT, LFT, GSH, PT/aPTT, ABG, CBS,

b) Radiological investigation
- Plain radiography (Skull, Chest, Cervical spine, Pelvis)
- Bedside echocardiography and FAST (Focused Assessment with Sonography in Trauma) or Extended FAST
- CT scan of the brain
c) ECG, Pulse oximetry, blood pressure
d) Other investigation depending on the assessment finding.


5) Management of this patient
- Triage the patient to the red zone with high priority
- Secure ther airway, breathing and circulation
- This patient may require intubation to protect the airway and prevent aspiration
- Set 2 large bore IV line
- Fluid management (resus patient with normal saline or Hartmann solution and maintain with normal saline. If BP not pick up, consider colloid and blood product)
- Inotropes support if BP remain low despite of aggressive fluid management
- Correct any anemia and start DIVC regime if indicated
- Take necessary investigation (as being mentioned before)
- Complete the secondary survey
- Stop any bleeding from open wound, fracture.
- Close monitoring of vital sign every 15 minutes until patient stable (BP, pulse rate, SPO2)
- Catherize the bladder
- Position the patient slightly 30 degree because suspected brain injury and increase ICP
- Insert the CVP line once patient stable
- Pain management (Sedate the patient and give analgesic like IV opiod)
- Definitive management base on type of injury
- Referral to surgical team, orthopedic team, neurosurgery and relevant disciplines