Can you say more about the cardiac injuries from your flail chest post? Contusion, tappenade. What are these like and how are they treated, and if someone has these on top of other injuries, what happens?
I got you! I wrote that post after a 10-hour hospital shift followed by an 8-hour school day so I just wanted to finish it and go to bed, but I'm rested now so let's get into it!
Pulmonary contusion: This is a bruised lung but can be mild or severe. If mild, it may have no immediate symptoms, but a severe pulmonary contusion can present with chest pain, difficulty breathing, coughing up blood-tinged sputum, and possible respiratory distress (fast breathing, wheezing, fast heartbeat, using chest muscles to breathe, pallor) or failure (normal or slow breathing, low blood pressure, slow heartbeat, lethargy, confusion, blue-tinged skin). Symptoms can present up to 24 to 48 hours after the injury in mild cases but can appear within hours in severe cases. When combined with other lung injuries, pulmonary contusion may require CPAP/BiPAP or ventilation. The patient will also receive pain medication and diuretics (medications that increase urine output) to reduce excess fluid in the lungs.
Myocardial contusion: This is a bruise on the heart muscle. Since the cells in the heart muscle don't regenerate like other body cells, myocardial contusions can lead to death of parts of the muscle and produce a syndrome similar to a heart attack. A patient will likely present with chest pain, shortness of breath, dizziness, stomach discomfort, low blood pressure, fast heart beat, palpitations, and distended neck veins. Myocardial contusions are treated with oxygen; IV fluids; and medications to raise the blood pressure, lower the heart rate, and control pain. Severe cases may be treated with cardiac bypass surgery or heart valve replacement.
Diaphragmatic injury/rupture: This is a tear in the diaphragm, the muscle under the lungs that causes them to inflate and deflate. This presents with respiratory distress. A herniation of the intestines into the chest can also occur, which can lead to loss of blood flow to and death of that section of intestine if left untreated. Diaphragmatic injury/rupture requires surgical repair, and the patient will have a chest tube (shown below) for a few days postoperatively.
Injury to the great vessels: The great vessels are the aorta and vena cava and injuries to them include tears/ruptures and aortic pseudoaneurysms, which may rupture. These are often asymptomatic until internal bleeding is substantial, in which case the patient will present with pallor, low blood pressure, and dizziness. A ruptured aortic aneurysm will present will tearing abdominal pain. These injuries are treated with surgical repair, blood transfusions, or endovascular repair (minimally invasive).
Tension pneumothorax/hemothorax/punctured lung: A tension pneumothorax occurs when a tear or puncture in the lung or pleural sac (membrane that surrounds the lung) allows air into the pleural space (between the lung and pleural sac) and compresses the lung. A hemothorax occurs when blood fills the pleural space and compresses the lung. These might sometimes be called "sucking chest wounds." Tension pneumothorax/hemothorax presents with respiratory distress or failure, asymmetric chest shape and expansion, the trachea being off-center in the throat, fast heart beat, low blood pressure, and distended neck veins. This is initially treated with needle decompression, in which a needle is used to puncture the pleural sac to let air or blood out, followed by insertion of a chest tube. If there are two simultaneous pneumothoraces/hemothoraces, surgery is indicated.
Cardiac tamponade [tam-po-NOD]: This like a hemothorax but in the sac that surrounds the heart (pericardial sac), and can present with chest pain, palpitations, and shortness of breath. Severe cases can present with dizziness, syncope, and confusion or lethargy. Cardiac tamponade is treated with pericardiocentesis, which is a needle inserted into the pericardial sac to drain the accumulated fluid. If this doesn't work, the sac is drained surgically.
Clavicular fracture: This is a fractured collar bone and presents like any fracture, with pain and swelling. In this case, the arm on the affected side will be displaced downward slightly. These are treated with immobilization with a sling for 6-12 weeks. If the bone protrudes through the skin or multiple displaced fractures are present, surgery is indicated.
Sternal fracture: This is a fracture of the sternum, or breast bone. These present with chest pain, pain with deep breathing and coughing, and swelling. Surgery is not required unless there are displaced or unstable fractures. Deep breathing exercises with pain management are encouraged.
Happy whumping!
