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Chest Injury


Works best if most of the serious injury has been excluded prior to transfer



Inclusion Criteria

  • Blunt (typically MVC) or penetrating (superficial stab) chest injury
  • Consultation with surgeon
  • Fewer than 3 rib fractures (excluding 1st or 2nd)
  • SBP >100, RR<24, O2Sat > 94% on 2L NC or less
  • CXR - absence of PTX, pulmonary contusion, wide mediastinum
  • Negative Chest CT
  • Need for parenteral analgesia

Exclusion Criteria

  • Hemodynamic instability or hypoxia
  • Thoracic / Gen surg want to admit to floor or O.R.
  • Positive imaging studies - pneumothorax, pulmonary contusion, wide mediastinum, pleural effusion, any vascular injury
  • Acutely abnormal ECG (blocks / changes) or significant arrhythmias
  • Other significant trauma - long bone fracture, head injury
  • Significant abdominal pain / tenderness

Potential Interventions

  • Continuous cardiac and oxygen saturation monitor
  • Analgesics
  • Incentive spirometry
  • Repeat CXR > 6 hours (or prn) after 1st CXR
  • Surgery consultation
  • Serial ECGs if suspicion for myocardial contusion

Discharge Criteria

Home

    • Stable vital signs
    • No evidence of PTX, pulmonary contusion, pneumonia
    • Adequate oxygenation (pO2>94% or RA)
    • Pain controlled with oral medications
    • Adequate incentive spirometer performance if blunt injury

Admit

    • Abnormal vital signs – HR>100, SBP<100, RR>22 despite therapy
    • Poor incentive spirometer performance – inadequate pulmonary toilet
    • Intractable pain
    • Acute thoracic injury - PTX, pulmonary contusion, pneumonia on repeat CXR
    • Hypoxia (<94%) on room air



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