Chest Trauma

This session is part one of two dealing with thoracic injuries. This session is pitched at FCEM examination standard and you are expected to be competent at leading a trauma response. Level 1 ultrasound accreditation (particularly FAST) is also assumed.

 

Where do you stick that chest tube?

Triangle of Safety

Chest Tube Insertion

The triangle of safety is bordered by the anterior axillary line (pectoralis major) and posterior axillary line (latissimus dorsi) and the 5th intercostal space (roughly the level of the nipple in a thin male). The only muscles you need to go through are the serratus anterior and intercostals. The only structure of significance is the long thoracic nerve. If injured it will produce a winged scapula. This is rare. This the first choice for chest tube insertion in trauma.

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Rib Fractures

Here’s a neat trick for finding hard to see rib fractures on standard chest xrays. Our eyes follow arches better than all these crazy lines and curves on the standard chest xray. So tip the xray on its side and make those curves into nice arches, then let your eyes follow them naturally


How to pick a pneumothorax on a supine CXR

The supine chest x-ray shows a deep sulcus sign on the left, which is a radiological sign seen in supine patients with pneumothorax. The deep sulcus sign represents lucency of the lateral costophrenic angle extending towards the hypochondrium.

Deep-sulcus-sign-of-supine-pneumothorax