Thoracic trauma

Objectives
General management tips
Trauma/emergency specific treatment
Fracture and dislocation (Rib fracture, Sternum
fracture, Sternoclavicular dislocation)
Pneumothoraix (Tension, open and
hemopeumothorax)
Acute pulmonary embolism
General management tips

1. Observe general appearance of athlete, determine

level of consciousness, and check ABCs if necessary.
2. Obtain a history if possible.
3. Measure vital signs.
4. Auscultate lungs for adventitious sounds
5. Palpate chest wall
6. Percuss chest wall
7. Directly observe chest wall.
8. Continue to monitor vital signs.
Fractures
Direct or indirect force
Fractures of ribs 10 through 12 may injure abdominal
organs such as the liver or spleen, whereas upper rib
fractures may injure the lungs.
Rib fracture
Rib fractures present with localized pain that
increases on compression of the rib cage. Crepitus at
the fracture site may also be felt with deep
inspiration.
Respiratory effort is limited because of pain, which
typically prevents the athlete from being able to take a
full breath
Rib Fracture (treatment)
Although fracture painful, a single rib fracture with no
internal injury does not constitute an emergency and
can be treated with rest, ice, and medication for
pain. X-rays are required for a definitive diagnosis
Fracture ( sternum)
Fractures of the sternum require a significant amount
of force and can be life threatening because the force
may be transmitted to the heart, lungs, or great
vessels of the chest.
Severe dyspnea, point tenderness, and sternal
deformity
Sternoclavicular Dislocation
Posterior dislocation of the sternoclavicular joint
may cause respiratory distress from the clavicle,
placing pressure on the trachea and surrounding
structures.
If the athlete is in respiratory distress, immediately
treat with basic airway maneuvers and
supplemental oxygen. If improvement is not noted
quickly, then reduction of the dislocation should be
attempted
Reduction of Sternoclavicular joint
Flail Chest
Chest to move in a paradoxical(opp.) manner during
respiration Isolated flail chest injuries may be treated by placing
the athlete on the affected side and transporting him or her to a
trauma centre.
The athlete’s own body weight on the affected side will act to
splint and support the flail chest.
If C-spine precautions are necessary, then the use of manual
pressure or placement of a large bulky dressing directly over the flail
segment may be beneficial in acting as a splint. High-flow oxygen
therapy, vital sign monitoring, and rapid transport are crucial.
If dyspnea increases, endotracheal intubation and positive
pressure ventilations must be considered.
Tension Pneumothorax
If breathing sounds are absent on the affected side and
severe dyspnea and jugular vein distension are present,
then a tension pneumothorax should be immediately
suspected
If the athlete is able to breathe adequately, give supplemental
high-flow oxygen and call EMS immediately. Monitor the
athlete closely and watch for deterioration in his or her
condition.
If the athlete is unconscious or unable to breathe
adequately, then assist respirations with a bag-valve mask. If
the symptoms still do not improve, needle decompression
must be performed rapidly
Open pneumothorax
An opening in the chest wall that allows air to enter
the pleural space is an open pneumothorax.
Treatment of an open pneumothorax involves
creating a one-way valve with a dressing
Covering the opening with a sterile occlusive dressing
sealed on three sides will allow air to leave the thorax
on exhalation but will seal off the opening so that air
does not enter the chest cavity on inhalation.
Open Pneumothorax
Hemothorax
Blood in pleural cavity
Effective treatment of a hemothorax includes oxygen
supplementation and respiratory support.
Acute pulmonary
embolism
Symptoms of an acute pulmonary embolism include a
sudden onset of
Chest pain, dyspnea, tachycardia, and bloody
sputum. Lung sounds may reveal wheezing, although
normal lung sounds are common.
Treatment includes
Early recognition, oxygen administration, and rapid
transport to the hospital