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Chest Trauma Dika
Chest Trauma Dika
Chest Trauma Dika
Blunt trauma.
Force distributed over larger area
Visceral injuries occur from:
Deceleration
Compression
Sheering forces
Bursting
Age Factors
Pediatric Thorax: More cartilage = Absorbs forces
Geriatric Thorax: Calcification & osteoporosis= More fractures
Penetrating Trauma
Low Energy
Arrows, knives, handguns
Injury caused by direct contact
and cavitation
High Energy
Military, hunting rifles & high
powered hand guns
Extensive injury due to high
pressure cavitation
Trauma.org
Closed pneumothorax
Open pneumothorax (including
sucking chest wound)
Tension pneumothorax
Pneumomediastinum
Hemothorax
Hemopneumothorax
Laceration of vascular structures
Traumatic Asphyxia
Rib Fractures
>50% of significant chest trauma cases due to blunt trauma
Compressional forces flex and fracture ribs at weakest points
Ribs 1-3 requires great force to fracture
Possible underlying lung injury
Ribs 4-9 are most commonly fractured
Ribs 10-12 less likely to be fractured
Transmit energy of trauma to internal organs
If fractured, suspect liver and spleen injury
Hypoventilation is COMMON due to PAIN
Flail Chest
Two or more ribs are broken in two or more
places that causes a free floating section.
Serious chest wall injury with underlying
pulmonary injury
Reduces volume of respiration
Adds to increased mortality
Paradoxical flail segment movement
Positive pressure ventilation can restore
tidal volume
Shortness of Breath
Paradoxical Movement
Bruising/Swelling
Crepitus( Grinding of bone ends on palpation)
Pulmonary Contusion
Pulmonary Contusion
Admission CXR
Pulmonary Contusion
24 Hours
Simple/Closed Pneumothorax
Occurs when lung tissue is disrupted and air leaks into the pleural space
It is a non-expanding collection of air around the lung.
Progressive Pathology
Air accumulates in pleural space
Lung collapses
Alveoli collapse (atelectasis)
Reduced oxygen and carbon dioxide exchange
Ventilation/Perfusion Mismatch
Increased ventilation but no alveolar perfusion
Reduced respiratory efficiency results in HYPOXIA
It may progress to Tension Pneumothorax
Chest Pain
Dyspnea
Tachypnea
Decreased Breath Sounds on Affected Side
Open Pneumothorax
Dyspnea
Sudden sharp pain
Subcutaneous Emphysema
Decreased lung sounds on affected side
Red Bubbles on Exhalation from wound ( a.k.a. Sucking chest wound)
Hypovolemia
Open Pneumothorax
Open Pneumothorax
Inhale
Open Pneumothorax
Exhale
Open Pneumothorax
Inhale
Open Pneumothorax
Exhale
Open Pneumothoarx
Inhale
Open Pnuemothorax
Inhale
Subcutaneous Emphysema
Occlusive Dressing
Tension Pneumothorax
Tension Pneumothorax
Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..
Tension Pneumothorax
Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..
Tension Pneumothorax
The trachea is
pushed to
the good side
Heart is being
compressed
Dyspnea
Tachypnea at first
Progressive ventilation/perfusion
mismatch
Atelectasis on uninjured side
Hypoxemia
Hyperinflation of injured side of
chest
Hyperresonance of injured side of
chest
Needle Decompression
Insert catheter ( 14g or larger) at least 3 in length over the top of the
3rd rib( nerve, artery, vein lie along bottom of rib)
Needle Decompression
Flutter Valve
Hemothorax
Accumulation of blood in the pleural space
Serious hemorrhage may accumulate 1,500 mL of blood
Mortality rate of 75%
Each side of thorax may hold up to 3,000 mL
Blood loss in thorax causes a decrease in tidal volume
Ventilation/Perfusion Mismatch & Shock
Typically accompanies pneumothorax
Hemopneumothorax
Hemothorax
Hemothorax
Hemothorax
Hemothorax
Hemothorax
Hemothorax
Hemothorax
Where does the blood come
from.
Meniscus of haemothorax
Meniscus of haemopneumothorax
Shock
Dyspnea
Tachycardia
Tachypnea
Diaphoresis
Hypotension
Dull to percussion over injured side (stony dull)
Frothy , bloody sputum
Flat Neck Veins
Management of Pneumothorax
Trachea
Expansion
Away
Decreased.
Chest may be
fixed in hyperexpansion
Midline
Decreased
Breath Sounds
Percussion
Diminshed or
Hyper-resonant
absent
May be
diminished
May be hyperresonant.
Usually normal
Diminished if
Dull, especially
large. Normal if
posteriorly
small
Haemothorax
Midline
Decreased
Pulmonary
Contusion
Midline
Normal
Normal. May
have crackles
Normal
Lung collapse
Towards
Decreased
May be reduced
Normal