CC Jan 2016 Sternal fracture

echoecho's version from 2016-03-06 19:57


Question Answer
Sternal fractures are a relatively common outcome of chest trauma, occurring in ____-_____% of reported blunt traumatic events in the US?3-8%
Fracture generally suggests what?A high-impact event and is frequently a result of front-impact motor vehicle accidents (MVAs)
Mandatory safety features including seat belts and air bags have reduced head injuries but what causes significant thoracic injury?rapid deceleration forces of a front-impact accident its restraint of thoracic movement
The frequency of sternal fractures has increased with the use of seat belts that cross the chest _______?diagonally
When these events occur at a relatively low speed, they do not cause intrathoracic injury but may result in what?Isolated sternal fracture (excludes rib, spinal, cardiothoracic, or vascular injury)
What two injury can occur in association with sternal fractures that are relate to impact speeds > 40 MPH? Aortic injury and myocardial contusion
80% of aortic injuries result in what?Immediate death
What are the clinical manifestations of isolated sternal fracture?Intense localized sternal or retro sternal pain that may be accompanied by contusion of hematoma, shortness of breath, pleuritic pain or direct tenderness
As with any blunt chest trauma, the immediate approach is the assessment and what?stabilization of airway, breathing and cardiac function, followed by a history of the mechanics of injury, a search for comordities and a thorough physical exam?
What findings raise concerns for intrathoracic injury?chest wall crepitus, deformity, unstable vital signs, dysthythmia, or severe dyspnea
Why do portable CxRs done in the ER lead to difficulty in assessing the mediastinal contents?due to projection artifact
Which X-rays lessen the problem of projection artifact?posterior anterior CXR
Recognition of sternal fracture is most likely achieved with what type of CXR? lateral (difficult to obtain an ER setting)
What is the optimal imaging? Why?1) CT using a multi detector CT (MDCT) and multiplayer reformation of the images 2) this technique evaluates pleural, pulmonary, and cardiovascular organs that are at high risk of injury in blunt chest trauma
When is MRI used?in special circumstances
Lab tests are recommended to rule out what?occult blood loss
Chest pain associated with sternal trauma can be difficult to distinguish from what syndrome especially in a patient with cardiac risk factors?ACS (acute coronary syndrome)
What procedure and labs are needed to evaluate the possibility of myocardial injury from infancy or myocardial contusion?EKG, cardiac biomarkers
Which patient does not require hospitalization?patient in whine cardiac studies and chest CT are negative
*** When is hospitalization and cardiac telemetry warranted?for patients who have increased cardiac troponin values after blunt chest trauma
True or false? The majority of sternal fracture heal without intervention?true
When is surgical repair considered?in cases with marked displacement of fracture fragments or in the event of nonunion
True or false? Surgical opinions are diverse regarding the indications and the best technique (wire or plate fixation) for surgical repair, but no randomized, controlled trials have born performed to address these questions?true
*** SUMMARY = Sternal fractures are relatively common outcome of chest trauma, occurring in what percentage of reporter blunt traumatic events in the US?3-8 %
*** SUMMARY = List the clinical manifestations of isolated sternal fracture?intense localized sternal or retrosternal pain that may be accompanied by contusion or hematoma , shortness of breath, pleuritic pain or direct tenderness
*** SUMMARY = What type of CXR is better visualizing sternal fracture than standard posterior-anterior CXR? Which imaging provides optimal visualization?1) lateral CXR 2) MDCT (multi-detector computer tomography)