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chest trauma - PowerPoint PPT Presentation

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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



  • 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

Intercostal nerve block
Intercostal nerve block

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.

Asherman chest seal
Asherman Chest Seal

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

  • 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

Tension pneomothorax2

Needle toracostomy
Needle toracostomy

Needle thoracostomy

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!


  • 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

Hemothorax physical findings
Hemothorax Physical Findings

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

Cardiac tamponade1
Cardiac tamponade

Becks triad

Pericardial tamponade physical findings
Pericardial TamponadePhysical Findings