1 / 50

Thoracic Trauma

Thoracic Trauma. Tintinalli Chapter 259. Introduction to Thoracic Trauma. 25% of civilian deaths Hospital mortality <5% Mechanism predicts mortality. Initial Resuscitation. Respiratory effort Poor effort / poor movement Good effort / poor movement Listen to neck. Initial Resuscitation.

gustav
Télécharger la présentation

Thoracic Trauma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Thoracic Trauma Tintinalli Chapter 259

  2. Introduction to Thoracic Trauma • 25% of civilian deaths • Hospital mortality <5% • Mechanism predicts mortality

  3. Initial Resuscitation • Respiratory effort • Poor effort / poor movement • Good effort / poor movement • Listen to neck

  4. Initial Resuscitation • Cardiac arrest during / after intubation • Inadequate preintubation oxygenation • Esophageal intubation • Mainstem intubation • Excess ventilation • Developed tension pneumothorax • Systemic air embolism • Vasovagal response • Sudden severe respiratory alkalosis

  5. Initial Survey • Treat life threatening injuries • Airway obstruction • Tension pneumothorax • Cardiac tamponade • Massive hemothorax • Open pneumothorax • Flail chest

  6. Initial Survey • Airway obstruction

  7. Initial Survey • Tension Pneumothorax • Exam • Treatment

  8. Initial Survey • Tension Pneumothorax • Exam • Treatment

  9. Initial Survey • Cardiac Tamponade • Blunt or penetrating trauma • Presentation • Diagnosis • Treatment

  10. Initial Survey • Cardiac Tamponade • Blunt or penetrating trauma • Presentation • Diagnosis • Treatment

  11. Initial Survey • Cardiac Tamponade • Blunt or penetrating trauma • Presentation • Diagnosis • Treatment

  12. Initial Survey • Massive Hemothorax • Mechanisms of lethality • Hypovolemia • Hypoxia • Vena cava compression • Treatment

  13. Initial Survey • Open Pneumothorax • Pathophysiology • Treatment

  14. Initial Survey • Open Pneumothorax • Pathophysiology • Treatment

  15. Initial Survey • Flail Chest • Definition • Examination • Treatment

  16. Ventilatory Support • Consider when: • Impaired ventilation that persists despite primary care treatment measures • Respiratory failure with flail chest • Shock • Multiple injuries • Comatose • Elderly

  17. Shock • Goal: Maintain tissue perfusion • Splanchnic perfusion • Capnometry • PETCO2 <28 mm Hg • P(a – ET)CO2 >10 mmHg • Hypovolemic Hypoptension • Blunt • Penetrating

  18. Treatment • Fluids • Correct hypotension ASAP • Access • Site choice • Stabilize intravascular volume

  19. Treatment • Chest tube and thoracotomy

  20. Cardiac Arrest • External massage (compressions) • Internal massage / thoracotomy • For all blunt injuries with thoracotomy • No SOL at scene: mortality 100% • Loose SOL on scene or enroute: mortality 97.5% • Lost SOL in ER: mortality 96% • For penetrating injuries with thoracotomy • Stab wounds: mortality 85% • GSW: mortality: 96%

  21. Diagnosis of Thoracic Injuries • Symptoms • Physical • Inspection • Percussion • Auscultation • Imaging

  22. Injuries to the Chest Wall • Bleeding • Open chest wounds • Tissue loss • Subcutaneous emphysema

  23. Injuries to the Chest Wall • Bleeding • Open chest wounds • Tissue loss • Subcutaneous emphysema

  24. Injuries to the Chest Wall • Bleeding • Open chest wounds • Tissue loss • Subcutaneous emphysema

  25. Injuries to the Chest Wall • Bleeding • Open chest wounds • Tissue loss • Subcutaneous emphysema

  26. Bony Injuries • Clavicular fractures • Rib fractures • First and second • Multiple • Flail Chest • Sternum fracture • Traumatic asphyxia

  27. Bony Injuries • Clavicular fractures • Rib fractures • First and second • Multiple • Flail Chest • Sternum fracture • Traumatic asphyxia

  28. Bony Injuries • Clavicular fractures • Rib fractures • First and second • Multiple • Flail Chest • Sternum fracture • Traumatic asphyxia

  29. Bony Injuries • Clavicular fractures • Rib fractures • First and second • Multiple • Flail Chest • Sternum fracture • Traumatic asphyxia

  30. Bony Injuries • Clavicular fractures • Rib fractures • First and second • Multiple • Flail Chest • Sternum fracture • Traumatic asphyxia

  31. Injuries to the Lungs • Pulmonary contusion • Pathphysiology • Diagnosis • Treatment

  32. Injuries to the Lungs • Hemothorax • Etiology • Pathophysiology • Diagnosis • Treatment

  33. Injuries to the Lungs • Pneumothorax • Pathophysiology • Diagnosis • Treatment • Complications

  34. Injuries to the Lungs • Pneumomediastinum • Pulmonary hematoma • Pulmonary laceration • Systemic air embolism • Intrabronchial bleeding • Aspiration

  35. Injuries to the Lungs • Pneumomediastinum • Pulmonary hematoma • Pulmonary laceration • Systemic air embolism • Intrabronchial bleeding • Aspiration

  36. Injuries to the Lungs • Pneumomediastinum • Pulmonary hematoma • Pulmonary laceration • Systemic air embolism • Intrabronchial bleeding • Aspiration

  37. Injuries to the Lungs • Pneumomediastinum • Pulmonary hematoma • Pulmonary laceration • Systemic air embolism • Intrabronchial bleeding • Aspiration

  38. Injuries to the Lungs • Pneumomediastinum • Pulmonary hematoma • Pulmonary laceration • Systemic air embolism • Intrabronchial bleeding • Aspiration

  39. Injuries to the Lungs • Pneumomediastinum • Pulmonary hematoma • Pulmonary laceration • Systemic air embolism • Intrabronchial bleeding • Aspiration

  40. Tracheobronchial Injury • Lower trachea and major bronchi • Deceleration • Forced expiration • Cervical tracheal injuries

  41. Diaphragm Injury • Etiology • History • Diagnosis • Treatment

  42. Penetrating Heart Injuries • Considerations • Diagnosis • Treatment

  43. Blunt Heart Injuries • Etiology • Types • Diagnosis table 259-4

  44. Blunt Heart Injuries • Blunt myocardial injury (BMI) • Patho • Diagnosis • Clinical • Radiological • EKG • Enzymes • Echo • Treatment

  45. Pericardial Inflammation Syndrome • Etiology • Diagnosis • Treatment

  46. Great Vessels of the Chest • Penetrating trauma • Stab > GSW • Diagnosis • History • Exam • Radiography • Treatment

  47. Great Vessels of the Chest • Blunt trauma • Diagnosis • History – chart 259-5 • Exam • CXR • CT • Treatment

  48. Special Considerations • Ascending aorta • Descending aorta • Innominate artery • Subclavian artery

  49. Espohageal and Thoracic Duct Injuries • Esophageal laceration • Thoracic duct

  50. Questions?

More Related