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INTRODUCTION

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Penetrating Chest Trauma. Victim of an assault suffered multiple gunshot wounds to his right chest. (Photo contributor: Lawrence B. Stack, MD.)

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CHEST AND ABDOMINAL TRAUMA: TRAUMATIC ASPHYXIA

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Clinical Summary

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The clinical findings of traumatic asphyxia are due to a sudden increase in intrathoracic pressure against a closed glottis. The elevated pressure is transmitted to the veins, venules, and capillaries of the head, neck, extremities, and upper torso, resulting in capillary rupture. Strangulation and hanging are common mechanisms. Survivors demonstrate plethora, ecchymoses, petechiae, and subconjunctival and retinal hemorrhages. Severe injuries may produce central nervous system injury with blindness, seizures, posturing, and paraplegia.

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Management and Disposition

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Treatment is supportive, with attention to other concurrent injuries. Long-term morbidity is related to the associated injuries.

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Pearls

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  1. Facial petechiae are known as Tardieu spots.

  2. One should be alert for associated rib and vertebral fractures.

  3. Perthes syndrome is traumatic asphyxia following thoracic crush injury.

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FIGURE 7.1

Traumatic Asphyxia. This 45-year-old man was pinned when the truck he was working under fell on his chest. He was unable to breathe for 3 to 4 minutes until his coworkers rescued him. The violaceous coloration of the shoulders, face, and upper chest is apparent. (Photo contributor: Stephen W. Corbett, MD.)

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FIGURE 7.2

Traumatic Asphyxia. A closer view showing the petechial nature of this rash. The patient was observed in the hospital overnight and recovered completely. (Photo contributor: Stephen W. Corbett, MD.)

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FIGURE 7.3

Tardieu Spots. Facial petechiae, also known as Tardieu spots, are seen in this child after an accidental strangulation injury. (Photo contributor: Lawrence B. Stack, MD.)

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FIGURE 7.4

Subconjunctival Hemorrhages. Bilateral subconjunctival hemorrhages are seen after an intentional strangulation injury. (Photo contributor: Lawrence B. Stack, MD.)

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FLAIL CHEST

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Clinical Summary

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A flail chest occurs when multiple rib fractures allow a section of the thoracic cage to move independently. The negative inspiratory pressure created by the diaphragm is less effective since the flail segment paradoxically moves in, creating problems with adequate ventilation. Pulmonary contusion, hemothorax, pneumothorax, and great vessel injuries frequently accompany a flail chest.

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Management and Disposition

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Pain control and pulmonary toilet are initial standard therapy. Mechanical ventilation should be reserved for those with respiratory compromise, not simply as a mechanism to stabilize the flail segment. Treatment of underlying pulmonary injuries and intensive care ...

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