Introduction to Thoracic Trauma

• Overview: Trauma in small animals requires a standardized diagnosis and treatment approach.

• Common Causes:

  • Blunt trauma (e.g., hit by car, falls, fights)

  • Penetrating injuries (less common) such as projectile injuries or impalement.

Trauma-Associated Pleural Space Diseases

Common Conditions

• Pneumothorax: Accumulation of air in the pleural space.

  • Types:

    • Open: Air enters through an external wound.

    • Closed: Air enters due to internal injury.

    • Tension: One-way valve effect causing pressure build-up.

  • Symptoms: Tachypnea, dyspnea, muffled heart/lung sounds.

  • Diagnosis: Auscultation, thoracocentesis (both diagnostic and therapeutic), ultrasound.

• Hemothorax: Accumulation of blood in the pleural space.

  • Signs: Signs of shock (tachycardia, pale mucous membranes).

  • Diagnosis: Thoracocentesis, thoracostomy tube if significant volume found.

• Chylothorax: Rare condition post-trauma, due to thoracic duct disruption.

Diagnostic Techniques

• Radiography: Looks for air retraction, consolidation, or floating heart.

• Ultrasound: Useful for identifying fluid accumulation, but may yield false positives.

Emergency Medical Treatment

Thoracocentesis Procedure

• Indications: Suspected cases of pneumothorax or hemothorax.

• Equipment: 60cc syringe, three-way stopcock, lidocaine.

• Technique: Insert needle via cranial edge of the rib at interspaces 8-11.

• Goals: Restore negative pressure, relieve respiratory compromise.

Hemothorax Management

• Initial Treatment: Volume expansion for shock, thoracocentesis for diagnosis and fluid removal.

• Surgical Intervention: Recommended for >7mL/kg retrieved.

Diaphragmatic Hernia

• Description: Organ displacement due to diaphragm rupture post-trauma.

• Diagnosis: Imaging techniques (radiography, ultrasound, CT).

• Surgical management: Delay until patient stability; surgery needed for strangulation or concurrent life-threatening injuries.

Trauma-Associated Pulmonary Disease

Pulmonary Contusion

• Characteristics: Hemorrhage and edema post-compression injury, leading to alveolar collapse.

• Signs: Tachypnea, dyspnea, cough/hemoptysis.

• Diagnosis: Clinical suspicion supported by physical exam findings and radiography.

• Management: Oxygen therapy, fluid resuscitation (care in case of overload), and avoid steroids.

Treatment Considerations

• Fluid Therapy: Monitor closely; avoid excess fluid to prevent worsening contusion.

• Oxygen Therapy: Maintain saturation >94%.

• Antibiotics: Infection risk low; treat if pneumonia symptoms arise.

Trauma Associated Thoracic Wall Injuries

Initial Management of Penetrating Injuries

1. Open thoracic wounds with dyspnea:

   • Immediate oxygen therapy and stabilization.

   • Cover wounds with air impermeable dressing.

2. Chest wounds with no dyspnea:

   • Approach to Diagnosis: Imaging to assess for penetration; lavage if none detected.

Imaging Techniques

• FAST Scan: Screen for pleural effusion, pneumothorax, and diaphragmatic hernia.

• Radiography: For confirming injuries; ensure stability beforehand.

• CT: Gold standard for identifying intrathoracic injuries.

Trauma Associated Cardiac Diseases

Arrhythmias Post-Trauma

• Types: Premature ventricular contractions, tachycardia.

• Management: Assess and correct electrolytes, treat with lidocaine if necessary.

References

• Various studies providing evidence and guidelines on trauma management, imaging modalities, and treatment protocols.