THORACIC TRAUMA

Kenyatta University Lecture

The Chest- anatomy

Thoracic cage Muscles Lungs / pleura Mediastinum Diaphragm Relations neck, abdomen, upper extremities

Mechanics of Breathing
Muscles of respiration Pleural pressures Lung elasticity

Situations of injury
Accidental Assault War Iatrogenic Spontaneous

Mechanisms of injury
Penetrating injuries -stab wounds - gun shots - iatrogenic Blunt trauma - RTAs - falls - falling objects

Iatrogenic Injuries
Central line insertion Cardiopulmonary resuscitation Esophagoscopy / dilatation of esophageal strictures Thoracotomy Sternotomy Thoracoscopy

Life Threatening Situations

Disordered mechanics of breathing - pneumothorax - flail chest - lung contusion - diaphragmatic herniation Volume loss Cardiac tamponade Cardiac arrythmias

Pneumothorax
Free air in the plural space Associated with surgical emphysema Penetrating injuries Open (sucking) chest wound Rib fractures Airway or esophageal rupture

Spontaneous pneumuthorax
Pulmonary tuberculosis Asthma Bulous lung disease Boehaaves syndrome

Pneumothorax cont
Progressive lung collapse Loss of tidal volume Rate compenstaion Increased resonance Loss of breath sounds Mediastinal shift

Tension pneumothorax
Respiratory decompensation Cardiovascular compromise impaired venous return Death without timely intervention

Diagnosis
History Examination CXR

Treatment
Chest tube insertion Triangle of safety Close / cover sucking wounds Bronchoplural fistula may need open repair Esopahgeal or airwair injury open repair

Hemothorax
Blunt and penetrating injuries Rib fractures Large vessel injury aortic disruption

Diagnosis
History of injury Palor Basal dullness / absent breath sounds CXR - Blunted CP angles Thoracentesis CT Scan

Treatment
Chest tube insertion Monitor output Thoracotomy indications - output based - associated injuries

Lung Contusion
Severe blunt injuries Associated rib fractures Localised / generalised lung solidification Respiratory distress CXR progressive opacification May need respiratory support

Flail Chest
Multiple rib fractures anteriorly and posteriorly Disorganised mechanics of ventilation Asssociated hemopneumothorax Positive pressure ventilation Surgical fixation of rib fractures

Diaphragmatic Rupture
Blunt or penetrating injuries Left sided more than right side Visceral herniation Pleural contamination Associated abdominal injuries - GIT - spleen, spleen, kidney, liver

Diagnosis
Respiratory distress Bowel sounds in the chest Peritonitis CXR - Bowel loops in the chest

Treatment
Surgical repair Interrupted non-absorbable sutures Abdominal approach Thoracic approach Pleural lavage and drainage

Other Chest Injuries

Tracheo-bronchial rupture Esophageal rupture Aortic disruption Myocardial contusion / laceration

Associated injuries
Head injury Abdominal injury Pelvis and Extremities Spine

Basics of Trauma Care

Airway Breathing Circulation Drugs

Surgical Intervention
Diagnosis high index of suspicion Chest tube insertion Positive pressure ventilation Thoracotomy / laparotomy