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chest trauma. Majid Pourfahraji. Anatomy. trauma. Trauma , or injury, is defined as cellular disruption caused by an exchange with environmental energy that is beyond the body\'s resilience .

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chest trauma
chest trauma

MajidPourfahraji

trauma
trauma
  • Trauma, or injury, is defined as cellular disruption caused by an exchange with environmentalenergy that is beyond the body\'s resilience.
  • Trauma remains the most common cause of death for all individuals between the ages of 1 and 44 years and is the third most common cause of death regardless of age.
primary survey
primary survey
  • The initial management of seriously injured patients consists of performing the primary survey (the "ABCs"—Airway with cervicalspine protection, Breathing, and Circulation); the goals of the primary survey are to identify and treat conditions that constitute an immediate threat to life.
main causes of chest trauma
Main Causes of Chest Trauma
  • Blunt Trauma: Blunt force to chest.
  • Penetrating Trauma: Projectile that enters chest causing small or large hole.
  • Compression Injury: Chest is caught between two objects and chest is compressed.
trauma to the chest
Trauma to the chest
  • Chest wall * Rib fracture * Flail chest
  • Airway obstruction
  • Pneumothorax * Simple/Closed * Open Pneumothorax * Tension Pneumothorax
  • Hemothorax
  • Flail Chest and Pulmonary Contusion
  • Cardiac Tamponade
  • Traumatic Aortic Rupture
  • Diaphragmatic Rupture
rib fracture
rib fracture
  • Blunt And Penetrating
  • PAIN
  • Shallow breathing
  • Atelectasis
  • Shunt: lack of ventilation respiratory and metabolic acidosis
simple pneumothorax
Simple Pneumothorax
  • Opening in lung tissue that leaks air into chest cavity
  • Blunt trauma is main cause
  • May be spontaneous : Cough
  • Usually self correcting
  • S/S
  • Chest Pain
  • Dyspnea
  • Tachycardia
  • Tachypnea
  • Decreased Breath Sounds on Affected Side
treatment for simple closed
Treatment for Simple/Closed
  • ABC’s with C-spine control
  • Airway Assistance as needed
  • If not contraindicated transport in semi-sitting position
  • Provide supportive care
  • Contact Hospital and/or ALS unit as soon as possible
treatment for simple closed1
Treatment for Simple/Closed
  • Thoracocentesis
  • Chest Tube or throcostomy
open pneumothorax
Open pneumothorax
  • An open pneumothorax or "sucking chest wound" occurs with full-thickness loss of the chest wall
  • Causes the lung to collapse due to increased pressure inpleural cavity
  • Can be life threatening and can deteriorate rapidly
  • Results in hypoxia and hypercarbia
  • Complete occlusion of the chest wall defect without a tube thoracostomy may convert an open pneumothoraxto a tension pneumothorax
  • Temporary management of this injury includes covering the wound with an occlusive dressing that is taped on three sides.
  • Definitive treatment requires closure of the chest wall defect and tube thoracostomyremote from the wound.
s s of open pneumothorax
S/S of Openpneumothorax
  • Dyspnea
  • Sudden sharp pain
  • Subcutaneous Emphysema
  • Decreased lung sounds on affected side
  • Red Bubbles on Exhalation from wound
tension pneomothorax
Tensionpneomothorax
  • Respiratory distress
  • Tachypnea
  • Tachycardia
  • Poor Color
  • Anxiety/Restlessness
  • Accessory Muscle Use
  • *Hypotension* But JVP +
  • Tracheal deviation away from the affected side
  • Lack of or decreased breath sounds on the affected side
  • Subcutaneous emphysema on the affected side
  • Hypotension qualifies the pneumothorax
  • Needlethoracostomy with a 14-gauge angiocatheter in the secondintercostal space in the midclavicular line
  • Tube thoracostomy should be performed immediately
tension pneomothorax1
Tension pneomothorax
  • The normally negativeintrapleural pressure becomes positive, which depresses the ipsilateralhemidiaphragm and shifts the mediastinal structures into the contralateralchest
  • the contralateral lung is compressed and the heartrotates about the superior and inferior vena cava; this decreases venous return and ultimately cardiac output, which results in cardiovascular collapse
flail chest
Flail chest
  • * Flail chest occurs when TWOor more contiguous ribs are fractured in at least twolocation
  • * additional work of breathing and chest wall pain caused by the flail segment is sufficient to compromise ventilation
  • * it is the decreased compliance and increased shunt fraction caused by the associated pulmonary contusion that is typically the source of post injury pulmonary dysfunction
  • * Treatment is intubation and mechanical ventilation (PEEP mode)
  • The patient\'s initial chest radiograph often underestimates the extent of the pulmonary parenchymal damage
  • Must chest tube if bleeding!
hemothorax
hemothorax
  • life-threatening injury number one
  • A massivehemothoraxis defined as >1500 mL of blood or, in the pediatric population, one third of the patient\'s blood volume in the pleural space
  • tube thoracostomyis the only reliable means to quantify the amount of hemothorax
  • After blunt trauma, a hemothorax usually is due to multiple ribfractures
  • occasionally bleeding is from lacerated lung parenchyma
  • a massivehemothorax is an indication for operativeintervention
  • Indication of emergency toracotomy
cardiac tamponade
Cardiac tamponade
  • life-threatening injury number two
  • Acutely, <100 mL of pericardial blood may cause pericardial tamponade
  • The classic diagnostic Beck\'s triad—dilated neck veins, muffled heart tones, and a decline in arterial pressure—often is not observed in the trauma
  • Increased intrapericardial pressure also impedes myocardial blood flow, which leads to subendocardialischemia
  • Best way to diagnose is ultrasound of the pericardium
  • Early in the course of tamponade fluid administration
  • a pericardial drain is placed using ultrasound guidance
  • Pericardiocentesis is successful in decompressing tamponade in approximately 80% of cases : 15 to 20 cc
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