Chapter 7: CHEST AND ABDOMEN

INTRODUCTION

CHEST AND ABDOMINAL TRAUMA: TRAUMATIC ASPHYXIA

Clinical Summary

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.

Management and Disposition

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

Pearls

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.

FLAIL CHEST

Clinical Summary

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.

Management and Disposition

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 unit admission ...