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Chapter 6 Thoracic Trauma

Chapter 6 Thoracic Trauma. Thoracic Trauma. Overview. Major signs and symptoms Immediate life-threatening injuries Pathophysiology and management Open pneumothorax Tension pneumothorax Massive hemothorax Flail chest Cardiac tamponade Cardiac involvement with blunt injury

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Chapter 6 Thoracic Trauma

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  1. Chapter 6 Thoracic Trauma

  2. Thoracic Trauma

  3. Overview Major signs and symptoms • Immediate life-threatening injuries Pathophysiology and management • Open pneumothorax • Tension pneumothorax • Massive hemothorax • Flail chest • Cardiac tamponade Cardiac involvement with blunt injury Other thoracic injuries Thoracic Trauma -

  4. Thoracic Trauma Thoracic injury is common. • 50% of multiple trauma • 25% of trauma deaths Potentially fatal thoracic injuries saved by rapid recognition and intervention. • Many require surgical intervention Thoracic Trauma -

  5. Chest Anatomy Thoracic Trauma -

  6. Mechanism of Injury Blunt • Direct compression • Fracture of solid organs • Blowout of hollow organs • Deceleration forces • Tearing of organs and blood vessels Penetrating • Direct trauma to organ and vasculature • Energy transmitted from mass and velocity Thoracic Trauma -

  7. Tissue Hypoxia Inadequate oxygen delivery Hypovolemia Ventilation/perfusion mismatch Pleural pressure changes Pump failure Thoracic Trauma -

  8. Thoracic Trauma • Shortness of breath • Chest pain • Hemoptysis • Cyanosis • Neck veins distended • Tracheal deviation • Asymmetrical movement • Signs and symptoms • Chest wall contusion • Open wounds • Subcutaneous emphysema • Shock • Tenderness, instability, crepitation (TIC) • Breath sounds abnormal Thoracic Trauma -

  9. ITLS Primary Survey “Deadly Dozen” • Airway obstruction • Open pneumothorax • Flail chest • Tension pneumothorax • Massive hemothorax • Cardiac tamponade Thoracic Trauma -

  10. ITLS Secondary Survey “Deadly Dozen” • Myocardial contusion • Traumatic aortic rupture • Tracheal or bronchial tree injury • Diaphragmatic tears • Esophageal injury • Pulmonary contusion Thoracic Trauma -

  11. Primary “Deadly Dozen” Airway obstruction • Secondary hypoxia • Common cause of preventable death • Foreign body, tongue, aspiration • Always assume cervical spine injury Thoracic Trauma -

  12. Primary “Deadly Dozen” Open pneumothorax • “Sucking chest wound” • Air enters pleural space • Ventilation impaired • Hypoxia results • Signs and symptoms • Proportional to size of defect Thoracic Trauma -

  13. Primary “Deadly Dozen” Open pneumothorax • Close chest wall defect • Load-and-go Thoracic Trauma -

  14. Primary “Deadly Dozen” Flail chest Thoracic Trauma -

  15. Primary “Deadly Dozen” Flail chest • Assist ventilation • Possible intubation • Load-and-go • Stabilize flail segment • Monitor for: • Pulmonary contusion • Hemothorax • Pneumothorax Thoracic Trauma -

  16. Primary “Deadly Dozen” Tension pneumothorax • Dyspnea • Anxiety • Tachypnea • Distended neck veins • Tracheal deviation (rare) • Breath sounds diminished • Hypertympany if percussed • Shock with hypotension Thoracic Trauma -

  17. Primary “Deadly Dozen” Tension pneumothorax • Decompress affected side • Respiratory distress and cyanosis • Loss of radial pulse • Decreasing level of consciousness • Load-and-go Thoracic Trauma -

  18. Primary “Deadly Dozen” Massive hemothorax • Anxiety and confusion • Neck veins • Flat: hypovolemia • Distended: mediastinal compression • Breath sounds decreased • Hypotympany if percussed • Shock Thoracic Trauma -

  19. Primary “Deadly Dozen” Massive hemothorax • Load-and-go • Treat for shock • Fluid administration • Titrate to peripheral pulse (90–100 mmHg) • Monitor for: • Hemopneumothorax Thoracic Trauma -

  20. Primary “Deadly Dozen” Cardiac tamponade • Beck’s triad • Hypotension • Neck veins distended • Heart sounds muffled • Paradoxical pulse • Breath sounds equal Thoracic Trauma -

  21. Primary “Deadly Dozen” Cardiac tamponade • Load-and-go • Treat for shock • Fluid administration • Titrate to peripheral pulse (90–100 mmHg) • Monitor and treat dysrhythmias • Monitor for: • Hemothorax • Pneumothorax Thoracic Trauma -

  22. Secondary “Deadly Dozen” Myocardial contusion • Most common cardiac injury • Blunt anterior chest injury • Same as myocardial infarction • Chest pain • Dysrhythmias • Cardiogenic shock (rare) • Treat as cardiac tamponade Thoracic Trauma -

  23. Secondary “Deadly Dozen” Traumatic aortic rupture • Most common cause of immediate death • Motor-vehicle collisions or falls from heights • 90% die immediately • Scene Size-up and history extremely important • No obvious sign of chest trauma • Hypertension in upper extremities and hypotension in lower extremities (rare) Thoracic Trauma -

  24. Secondary “Deadly Dozen” Tracheal or bronchial tree injury • Subcutaneous emphysema • Chest, face, neck • Ensure adequate airway • Cuffed ET tube past site of injury • Monitor for: • Pneumothorax • Hemothorax Thoracic Trauma -

  25. Secondary “Deadly Dozen” Diaphragmatic tear • Severe blow to abdomen • Herniation of abdominal organs • More common on left • Breath sounds diminished • Bowel sounds auscultated in chest (rare) • Abdomen appears scaphoid Thoracic Trauma -

  26. Secondary “Deadly Dozen” Esophageal injury • Penetrating trauma • Difficult to assess in field • If unrecognized, may be lethal Thoracic Trauma -

  27. Secondary “Deadly Dozen” Pulmonary contusion • Common from blunt trauma • Hours to develop • Marked hypoxemia Impaled object • Do not remove • Gently stabilize object • Avoid movement Thoracic Trauma -

  28. Other Chest Injuries Traumatic asphyxia • Severe compression • Ruptures capillaries • Cyanosis above crush • Swelling of head, neck • Swollen tongue, lips • Conjunctival hemorrhage Thoracic Trauma -

  29. Other Chest Injuries Simple pneumothorax • Fractured ribs • Pleuritic chest pain • Dyspnea • Decreased breath sounds • Hypertympany if percussed • Monitor for: • Tension pneumothorax Thoracic Trauma -

  30. Other Chest Injuries Sternal fracture • Significant blunt trauma to anterior chest • Signs of fracture on palpation • Myocardial contusion presumed Simple rib fracture • Most frequent chest injury • Monitor for: • Pneumothorax • Hemothorax Thoracic Trauma -

  31. Summary Chest injuries common Often life-threatening • Require prompt recognition • Require prompt intervention • Frequently require load-and-go Airway and oxygenation always priority Frequent Ongoing Exams Thoracic Trauma -

  32. Discussion Thoracic Trauma -

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