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Rapid deceleration injuries
Several CXR features might suggest the injury according to ATLS
- Widened mediastinum the most reliable sign
- Fractures of the first and second ribs
- Obliteration of the aortic knob
- Deviation of the trachea to the right
- Presence of a pleural cap
- Elevation and rightward shift of the right main stem bronchus
- Depression of the left main stem bronchus
- Obliteration of the space between the pulmonary artery and the aorta
- Deviation of the nasogastric tube to the right
Investigation of choice.
- Contrast CT thorax
- Control hypertension (systolic no more than 110 mmHg) and tachycardia with appropriate analgesia; labetalol is the agent of choice to control acute hypertension in this setting.
- Surgical repair or endovascular stenting, which may require transfer from your facility