True about chest trauma:

Ans. is 'a', 'b' & 'c' i.e. 'ECG done in all cases a/w sternal fracture', 'Under water seal drainage if a/w pneumothorax' & 'X-ray chest investigation of choice' Thoracic trauma account for 20 to 25% of all trauma related deaths. Rib fractures are the most frequent injury after blunt thoracic trauma. X-ray chest is the inv. of chocie. About 80% of chest injuries can be managed non-operatively, with simple procedures such as clinical observation, thoracocentesis, respiratory suppo and adequate analgesia. Tube thoracostomy is the most common procedure performed in the management of thoracic trauma. Emergency thoracotomy is indicated after chest trauma in following conditions. 1.Cardiac arrest (resuscitative thoractomy) 2.Massive hemoththorax (> 1500 mL of blood through the chest tube acutely or > 200-300 mL/hr after initial drainage. 3.Penetrating injuries of the anterior aspect of the chest with cardiac tamponade. 4. Large open wounds of the thoracic cage. 5.Major thoracic vascular injuries in the presence of hemodynamic instability. 6. Major tracheobranchial injuries. 7. Evidence of esophageal perforation. About option 'a' i.e. ECG done in all cases a/w sternal fracture Sternal fractures may be associated with blunt cardiac injury. So ECG & chest X-ray done in all cases. ECG, though not specific, is sensitive in identifying potential problems. Patients with isolateral sternal fractures and a normal ECG and chest X-ray need no fuher investigation and can be safely discharged on oral analgesics. Patients with abnormality on ECG or chest X-ray need fuher cardiological evaluation with continuous ECG monitoring, serial CPK-MB measurement and echocardiography.