Investigations to be done during a Chest trauma before interventions. The reference is from the book bailey and love and SRB surgery books.

1. Investigations
for Chest
trauma.

2. Investigations:
● Investigation of chest trauma is based
on clinical examination, supplemented
by chest radiography.
 Ultrasound – eFAST.
 Underwater Chest drain.
 Chest Radiograph.

3. ● Ultrasound- Extended Focused Assessment
with Sonar for Trauma (eFAST).
● Ultrasound can be used to differentiate between
contusion and the actual presence of blood.
● This technique uses sonar assessment in the
chest, looking for a cardiac tamponade or free
blood and air in the hemithorax on each side,
● Assessment for blood in the abdominal cavity, in
sub-diaphragmatic spaces and pelvis.

5. Chest Radiograph.
● If the patient is haemodynamically unstable or the
spine is at risk, an anteroposterior (AP) supine chest
radiograph is done which will provide information
regarding tracheal deviation, lung and mediastinal
pathology, as well as skeletal injury.
● In penetrating injury, chest radiograph is performed in
the erect position, as this will best reveal a small
pneumothorax, fluid meniscus, air–fluid level or the
presence of free gas under the diaphragm.
● The presence of thoracic skeletal injury might also
injure the abdominal viscera.

6. ● Rupture of the thoracic aorta can be seen in
fractures of the first and second rib, bilateral
clavicular fracture, fracture of the sternum,
thoracic spine or scapula.
● Fracture of the lower ribs can injure the liver or
spleen.
● Fracture of ribs can injure the lung parenchyma
or thoracic wall vasculature, causing
pneumothorax, haemothorax or lung contusion.

10. Computed tomography scan.
● Principal and most reliable examination for
major injury in chest trauma.
● In blunt chest trauma, the CT scan identifies
fractures, haematomas, pneumothorax and
pulmonary contusion. In penetrating chest
trauma, the scan show the track or presence of
the missile and allow the proper planning of
definitive surgery.

11. ● Also detects the migration of abdominal
contents into the chest in case of rupture of
diaphragm.
● It is the diagnostic modality of choice for the
assessment of the thoracic aorta and
mediastinal vessels.

12. Pneumothorax

14. Reference:
Bailey and Love’s Short Practice of Surgery – 27th edition
SRB’s Manual of Surgery – 5th edition

15. Thank you.