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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 • 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 As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!
OVERVIEW • Causes of Thoracic Trauma • Types, Signs and Symptoms, and Management of Thoracic Trauma
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 • 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 • Severity is directly proportional to the size of the wound • Atmospheric pressure forces air through the wound upon inspiration
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 • Apply an Asherman Chest Seal • Occlusive dressing with a release valve • Observe for development of a Tension Pneumothorax
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 • ANXIETY! • Increased respiratory distress • Unilateral chest movement • Unilateral decreased or absent breath sounds
LATE S/S OF TENSION PNEUMOTHORAX • Jugular Venous Distension (JVD) • Tracheal Deviation • Narrowing pulse pressure • Signs of decompensating shock
JVD & TRACHEAL SHIFT Decreased input and output from the heart with compression of the great vessels
JVD & TRACHEAL SHIFT Increased pressure moves mediastinum and compresses the lung on the uninjured side
MANAGEMENT OF TENSION PNEUMOTHORAX • Asherman Chest Seal • Needle Decompression • High flow oxygen (If available) • Bag Valve Mask / Intubation • Chest Tube (BN CCP/CASEVAC)
RGR MEDIC CHEST TUBE INSERTION
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 • 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