1. -Tachycardia, Tachypnea, SOB, and Chest pain are all common S/S in any Chest trauma pathology -Cardiac contusion is not a/w breathing abnormality
2. CXR=hours after trauma the lung parynchema opacification appears
   1. Dx. lung contusion
      1. Rx. I. admit and observe for 2 days r/o pulmonary edema, give O2 & Pain medication, & Pulmonary toilet. II. Intubate, & Ventilate
3. S/S: Hyperresonance
   1. Dx. Pneumothorax
      1. Inv. I. Upright CXR; II. lateral CXR can be used to find a small pneumothorax
         1. Rx.
4. Chest bruises may indicate rib fractures
   1. Flial chest
5. Dull on percussion
   1. Dx. Hemothorax
6. Hypotension+Distended neck veins
   1. Hyperresonance, trachea & mediastinum shift awa from the site of the pneumothorax
      1. Dx. Tension Pneumothorax
         1. Rx. 1st large bore needle decompression, 2nd: chest-tube thoracotomy
   2. Dx. Cardiac tamponade
      1. Subtopic 1
7. POSITIVE NEW EKG FINDINGS
   1. Dx. Cardiac contusion injury
      1. Inv. Trans-Esophageal Echo, or CT to Rule out Aortic injury
         1. I.NO rx. for Cardiac injury with positive markers (CKP, troponin), and normal EKG, II.if sever contusion may lead to cardiogenic shock
8. CXR=small linear bands, or wedge- shaped densities,morbidity, raised diaphragm, unaffected side show hyper-inflation
   1. Dx. Atelectasis
9. Hx. of sever stress, trauma, or infection
   1. CXR=Diffuse Bilateral infiltration & pulmonary capillary wedge pressure less than 18 mmHg, & PaO2/FiO2 ration, is less than 200
      1. Dx. Adult Respiratory Distress Syndrome
         1. Rx. underlaying cause & I.V. Fluids & Ventilation
            1. 1st Ventilation setting: FiO2 70%, PEEP 9cmH2O, Tidal volume less than 6ml/Kg, plateau pressure less than 30
            2. after achieving normal or slightly acidic pH, a pulse ox. = 90%, PaO2=60
            3. 2nd: Adjust Ventilation setting to : PEEP= 5cm H2O, FiO2 around 50%
   2. ANY or NO CXR finding w/ CLINCAL SUSPECION from Hx. of immobility, surgery, fracture, child delivery, Infection, drug abuse, CA, or DVT,P.E.: SOB w/ Clear chest
      1. Dx. Pulmonary Embolization
         1. Inv. 1st: after CXR (PA & Lat. ) do a V/Q scan 2nd: do am U/S at the site of DVT if present 2ed: do spiral CT 3ed: Venography with LMWH (usu. NOT needed)
            1. Rx.
            2. Stable
            3. Heparin & Warfarin
            4. Unstable (Shock or hypoxia)
            5. Thrombolytic drugs
            6. Recurrent PE
            7. Infe. Vena. Cap filter