44 THORACIC TRAUMA MC cause of -morfality im bluxt thoracic frouwa Tochto- brorchiel injury MC cone of -marfaty im pendtrating thaace Foua — Hematherx [senders to prironary lacerotion] RB FRACTURES oo 01 17 al Vad ae I a ib A are uncommon - Need high velaity impact i TE rib froctured , susped’ injury to» Sub clavion vessels 4 Brocka! pleras 5 heats Th beh fractured, sueped c Left Splenic mjory > Right: Liver injury : Management of simp rib Adequate anelgeria No strapping Ribs Me frodiral during CPR be FLAIL CHEST 00 03 53 + Definition © # of 3 or wore contiguous ribs in atlesl 2 locations Flot chest c Underlying gulmonary_ Confusions [ Leoding cowe of merfaity) Forodoxical Yespitotion, Moragement © Adequate ovalgsio i oxygeration TF 70s < Comm Hy . FRI 18/mim Still, qrpv [Trlermittent Tacitive Treasure Ventilation) | Tt 7 < 60 memllg RED Ufmin still, l Surgical comredtion of flail segment Version 1.2 / Marrow 3.0/ 201942 TENSION PREVMOTHOEAX 00 lo &e "Trauma Freumetheros wath Topi hemodynamic compro Conditions Feretiating | Sucking Wound in chest wall Palmonary laceration and tev it being given without a cheat fibe muel Tracheo - bronchial injury The injury im chest wall forme a One-way velye Air accumulating cones Jame side eng Yo cllague , opposite lang hyprinflte Lefer medina daft” eceurs Causing hemodyremie changer ,|4C0 * Tar x sv) TWP Vssr TRE Tenor preundhorax Hyfeeresonant om percussion, absent byesth sound Cardiac tamponade Muffled heorf sourds Another way Yo differentiate above 2 conditions, ¢FAST Tension. preamethorox ic a clinical diagnosis Momagement : Emergency Needle Aeneocenisi Wide bore Lv needle in, Adults: S**inter-castal Spece Slightly anterior te ba oxi lar ie Children "4 inter costal space, wid -clavicular line Definitive Tube thorococenteric © Insertion of am inter. cafal tube in triongle of softy , and cover Suckiry wound with gauze pice ond Tope om 3 sides SIMPLE PNEUMOTHORAX oor we No hemodynamic Compromite TE pevwethorox >Y3™ of pleural spoce or Trespirofory whe , diced intee-coffal tube insertion done (ter) No role of meedle therococentenr Version 1.2 / Marrow 3.0/ 2019HEMOTHORAY Recumuletion of blood m pleural space Trtercorla! vessels Kevoy Pir-flud level © Percussion Dull note Monogement ICT insertion in triangle of adtly Trdicotions for ewer: rey thoracciow: Output 21ST off Time of Tube insertion 7 dovecfhe for 3 consecuitve heure Hemodqnamic Compromite 3 E Chait tube] icter-catal tate (£01) > Plusays inserted im Ariorgle of safety Boundaries of triorale of Salty Perterierly — Rterier asnlany bola Posterorly » Ferterior ouillary fed Apex Arille Bose: $ inher colfel space Alweys inserted of upper border of [ower rib Chest tube'’s other end tt placed in on urder- water geal TE column of wolty mover “p ond down with tock breath in under-woler teal, confirme right [corre petition of chest fube Toritioning on Foray Correct, position is when all holes | eyee of chet tube ore ingide Thorocie cavity Stopped column meve ment Blocked | dbsplaced tube Excessive bubbling in waler column Brorhopleural Fictala Jo hemathores| thoracslemy T¢f a removed wher lung expands ond oulpel < 50-15 ccf ttohe Chat tube is removed af peat of insprobion whit patent holds breath Version 1.2/ Marrow 3.0/ 2019 a E46 CARD IHMPONADE ar Fopid occumulation of blood tm prricordiol space Soe blood - con couse tomporode Usvol couse «¢ ptrdivoting Nowe. P Brehr Mod Moffled beat tourds, hypetenion, roised IVF Us chiracal dingmotis Menage ment Emergency Needle pencenbocentenn Needle tm sub: sighed (us*4 sen) orea, diveded Touords ft huulder tip , under Uh or ECHO quidence Low of seuitlance iwdscater tring te pircordiol spore Blox ovpivated TC complication Arrythonios Definitive - Thovorclomy filloned by pericardial window creation © Trauma STERNAL FRACTURE 60 Uncommon , rewiring & high-velutiy irmpact Th occurs, suspect — Myocarda! corfution Monitoring Serial 12 leod Eths , Cordioe enayymer : Traumatic DIAPHRAGMATIC INJuTY 00 2 -F4 + Occurs usually in blunt travme Left cide >right side Delayed presentation Features: Respiratory, dative ; bowel founds in chert conty Xvaq » Bowel loops | Rylee Tube in thorocic couthy : Monagement Surgery vie, obdemnal | Frevocic approach Fe pose din phtogym using mesh and chet Tube insertion Version 1.2 / Marrow 3.0/ 2019IDIC RT IONS OF THORACOTOMY “oo 4S a ~ Hemothorae p> Oulpul >16h at time of Tube incerTion [ > p00ce [hr for 3 concecutive heurs ° Hemedgmamre Compromite or Cordine Tomporede Porte inyary ME site just distal fo. ligomertum arleriosom Esophageal injury a Chy lothorox 8 Tm Thoroere Tyaume, arteyo- lateral thorcctors dene, waswally Z 3 NECK TRAUMA 08 Trauma neck zones Lonel Thoracre inlef To upper border of cricoid cartilage [Vitel ctrwetines ©, Zove astecicted with marinumn aorta ty ] Lore S Cricerd To angle of ‘mordible [Mer exposed mast injury prone, mail Surgically occecssble rove) Zone *G Arale of wordible to base of skull All gun- that wourds fo meck meed 0 surgical exploration Lore E pendhatting fajary * Majorit os} Supecticiol (mevation , patient stble “ Tlakysme breached unfabe \ Local exploration followed by safunng Formal eck exploration Version 12! 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