THORACIC TRAUMA
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THORACIC TRAUMA. YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!. INTRODUCTION. Each year there are nearly 150,000 accidental deaths in the United States 25% of these deaths are a direct result of thoracic trauma An additional 25% of traumatic deaths have chest injury as a contributing factor.

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Introduction l.jpg
INTRODUCTION

  • Each year there are nearly 150,000 accidental deaths in the United States

  • 25% of these deaths are a direct result of thoracic trauma

  • An additional 25% of traumatic deaths have chest injury as a contributing factor



Reason l.jpg
REASON

As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!



Overview l.jpg
OVERVIEW

  • Causes of Thoracic Trauma

  • Types, Signs and Symptoms, and Management of Thoracic Trauma


Causes of thoracic trauma l.jpg
CAUSES OF THORACIC TRAUMA:

  • Falls

    • 3 times the height of the patient

  • Blast Injuries

    • overpressure, plasma forced into alveoli

  • Blunt Trauma

  • PENETRATING TRAUMA


  • Open pneumothorax l.jpg
    OPEN PNEUMOTHORAX

    • Develops when penetration injury to the chest allows the pleural space to be exposed to atmospheric pressure - “Sucking Chest Wound”

    • Q- WHAT MAY CAUSE A SCW?

    • Examples Include:

      • GSW, Stab Wounds, Impaled Objects, Etc...


    Large vs small l.jpg
    LARGE VS SMALL

    • Severity is directly proportional to the size of the wound

    • Atmospheric pressure forces air through the wound upon inspiration


    S s open pneumothorax l.jpg
    S/S: OPEN PNEUMOTHORAX

    • Shortness of Breath (SOB)

    • Pain

    • Sucking or gurgling sound as air moves in and out of the pleural space through the wound


    Management of scw l.jpg
    MANAGEMENT OF SCW

    • Apply an Asherman Chest Seal

      • Occlusive dressing with a release valve

    • Observe for development of a

      Tension Pneumothorax


    Tension pneumothorax l.jpg
    TENSION PNEUMOTHORAX

    • Air within thoracic cavity that cannot exit the pleural space

    • Fatalif not immediately identified, treated, and reassessed for effective management



    Early s s of tension pneumothorax l.jpg
    EARLY S/S OF TENSION PNEUMOTHORAX

    • ANXIETY!

    • Increased respiratory distress

    • Unilateral chest movement

    • Unilateral decreased or absent breath sounds


    Late s s of tension pneumothorax l.jpg
    LATE S/S OF TENSION PNEUMOTHORAX

    • Jugular Venous Distension (JVD)

    • Tracheal Deviation

    • Narrowing pulse pressure

    • Signs of decompensating shock


    Jvd tracheal shift l.jpg
    JVD & TRACHEAL SHIFT

    Decreased input and output from the heart with compression of the great vessels


    Jvd tracheal shift21 l.jpg
    JVD & TRACHEAL SHIFT

    Increased pressure moves mediastinum and compresses the lung on the uninjured side


    Management of tension pneumothorax l.jpg
    MANAGEMENT OF TENSION PNEUMOTHORAX

    • Asherman Chest Seal

    • Needle Decompression

    • High flow oxygen (If available)

    • Bag Valve Mask / Intubation

    • Chest Tube (BN CCP/CASEVAC)


    Slide23 l.jpg

    RGR MEDIC

    CHEST TUBE INSERTION


    Needle thoracentesis l.jpg
    NEEDLE THORACENTESIS

    • Locate 2nd or 3rd Intercostal Space at the Midclavicular Line

    • Insert a 14g needle/catheter over the top of the rib (“VAN”) into the pleural space

    • Listen for air escape (WHOOSH!)

    • Leave the catheter in place

    • Reassess




    Summary l.jpg
    SUMMARY

    • Reviewed anatomy and physiology of the chest

    • Discussed causes of trauma to the chest

    • Signs, symptoms, and emergent management of:

      • OPEN PNEUMOTHORAX

        Asherman Chest Seal

      • TENSION PNEUMOTHORAX

        Needle Thoracentesis



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