Trauma Of Great Vessels

  • Bruits on auscultation of the chest may indicate vascular injury.
  • Foreign body (eg, bullet) within the chest that appears "fuzzy" on CXR may indicate vascular injury. Blurring of the borders of the foreign body may occur because of movement with cardiac pulsations.
  • Never probe a chest wound or remove an impaled FB because you may dislodge a clot and cause massive hemorrhage.
In penetrating chest trauma, ED thoracotomy is indicated if:
  • Patient loses signs of life in the ED or immediately before arrival (especially with narrow PEA).
  • SBP < 50 mmHg not responsive to fluids/blood
  • Severe shock with signs of tamponade