Pneumothorax Haemothorax Flail chest Cardiac

Air in the pleural cavity Blood in pleural cavity Successive 3 or more ribs fracture
De
f.
at 2 or more sites
-Spontaneous (1ry, 2ry) -Traumatic Severe trauma Trauma
Etiology

-Traumatic -Iatrogenic
-Spontaneous
-Bloody effusion
-Penetration of chest wall -Isolated or haemopneumothorax -Paradoxical breathing -Myocardium
-Laceration of lung -Pulmon.Contusion:V/P Contusion
-Rupture of tracheobronchial tree mismatch Tear
-Injury by fractured ribs -Rib fracture pain▼ventilation Septal injury
Patho.

-Rupture of alveoli interstitial  atelactasis -Valve

emphysema mediastinal emphysema -Pneumo/hemo thorax -Coronary injury
 pneumothorax or surgical -Pendulum like movement of -Haemopericardium
emphysema dead space air Open
-Mediastinal flutter+kink of great Closed
vessels
-Communication: open/close -Mild: 100-350 ml -Ant.
-Tension: simple/tension -Moderate: 350-1500 ml -Lat.
Types

-Severe: 1500-3000 ml -Post. (Least dangerous)

-Flail sternum
RDS, Cough, pain, dyspnea, acidosis, -▼BP, ▲HR -Severe trauma, pain Cardiac tamponade:
Prsenetation

hypercarbia,▼ resp. movement -Severe trauma, pain -Dyspnea, tachypnea, cyanosis -Beck's triad (▼BP,▼HS,congested
ipsilateral, diminished air entry, hyper- -Dullness and ▼ air entry -▼BP, ▲HR neck veins)
resonnace on percussion -Tachypnea -Paradoxical mov.of flail -Kussmaul's sign
-Pallor segments -Pulsus paradoxus
-Contusion+surgical emphysema -Cyanosis of upper half of body
-CXR: mediastinal shift in tension, jet -CXR: PA, Grading -X-ray -CXR (▲cardiothoracic ratio)
Investigatio

back color + grading -CT -ECHO

-CT -MSCT -CT
ns

-ABG -CVP measurement

-Pericardiocentesis
 -Conservative: mild -Minimal: conservative -Oxygen -Conservative
-ICT (2nd intercostal space, -Mild: aspiration -Pain relief -Pericardiocentesis (20 cc, ECG
midclavicular line) -Moderate to severe: ICT (5th or 6th -Pulmonary toilet guided to avoid myocardial injury)
-ICTD (tension) intercostal spaces, midaxillary line) -Stabilize Lt thoracotomy
Rx

-Close leakage (open) -Thoracotomy (INDICATIONS) -External strapping

-Pleurodesis -CPAP
-Surgery (VATS/ open): Cx and Cause -IPPV
-Internal stabilization
-Persist -Clotting
complica

-Recurrence -Organization and adhesion

tions

-Tension -Infection
-Hemothorax
Indications of thoracotomy: Cardiac tamponade is fatal
-Failure of drainage RV is most vulnerable to injury
-1500 ml (substernal)
N/B

-200ml/hr for 3 consecutive hours Flask shaped heart only in chronic

-Associated pathology cases
-Clotted haemothorax (if organized
decortications)