Majid Pourfahraji chest trauma - PowerPoint Presentation

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Majid

Pourfahraji

chest trauma

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Anatomy

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Trauma

, or injury, is defined as cellular

disruption

caused by an exchange with environmental energy that is beyond the body's

resilience

.

Trauma

remains the most common cause of death for all individuals between the ages of 1 and 44 years and is the third most common cause of death regardless of age.

trauma

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The

initial

management of seriously injured patients consists of performing

the

primary

survey

(

the "ABCs"—Airway with cervical spine protection, Breathing, and Circulation); the goals of the primary survey are to identify and treat conditions that constitute an immediate threat

to

life.

primary survey

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Blunt

Trauma:

Blunt force to chest.

Penetrating

Trauma

:

Projectile that enters chest causing small or large hole.

Compression Injury: Chest is caught between two objects and chest is compressed.

Main Causes of Chest Trauma

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Chest wall

* Rib fracture

* Flail chest

Airway obstruction

Pneumothorax

* Simple/Closed

* Open Pneumothorax

* Tension Pneumothorax

Hemothorax

Flail Chest and Pulmonary Contusion

Cardiac

Tamponade

Traumatic Aortic RuptureDiaphragmatic Rupture

Trauma to the chest

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Blunt

And

Penetrating

PAIN

Shallow breathing

Atelectasis Shunt: lack of ventilation respiratory and metabolic acidosis

rib

fracture

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Anatomy

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Intercostal

nerve block

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Opening in

lung

tissue that leaks air into chest cavity

Blunt

trauma is main cause

May be

spontaneous : Cough

Usually self correctingS/S

Chest

Pain

Dyspnea

Tachycardia

Tachypnea

Decreased Breath Sounds on Affected Side

Simple

Pneumothorax

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Treatment

for Simple/Closed

ABC’s

with C-spine control

Airway Assistance as needed

If not contraindicated transport in

semi-sitting position Provide

supportive

care

Contact

Hospital

and/or ALS unit as soon as possible

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T

horacocentesis

Chest

Tube or

throcostomy

Treatment

for Simple/Closed

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Chest tube !!

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An open pneumothorax or "

sucking

chest wound" occurs with full-thickness loss of the chest

wall

Causes

the lung to collapse due to

increased pressure

in pleural cavityCan be life threatening and can deteriorate rapidly

Results

in

hypoxia

and

hypercarbia

Complete occlusion of the chest wall defect

without

a

tube

thoracostomy

may convert an open

pneumothorax

to

a tension

pneumothorax

Temporary

management of this injury includes covering the wound with an occlusive dressing that is

taped on

three sides

.

Definitive

treatment requires

closure

of the chest wall defect and

tube thoracostomy remote from the wound.

Open

pneumothorax

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Occlusive Dressing

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Asherman

Chest

Seal

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Dyspnea

Sudden sharp

pain

Subcutaneous

Emphysema

Decreased lung sounds on affected side Red Bubbles on Exhalation from wound…

S/S of

Open

pneumothorax

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Respiratory

distress

Tachypnea

Tachycardia

Poor Color

Anxiety/Restlessness

Accessory Muscle Use *Hypotension* But JVP +

Tracheal deviation

away from the affected side

Lack of or

decreased

breath

sounds on the affected side Subcutaneous emphysema on the affected side Hypotension qualifies the pneumothorax Needle

thoracostomy

with a

14

-gauge

angiocatheter

in the

second

intercostal

space in the

midclavicular

line

Tube

thoracostomy

should be performed immediately

Tension

pneomothorax

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The

normally negative

intrapleural pressure becomes positive, which depresses the ipsilateral

hemidiaphragm

and shifts the

mediastinal structures into the contralateral chest the contralateral lung is compressed and the heart rotates about the superior and inferior vena cava; this decreases venous return and ultimately cardiac output, which results in cardiovascular collapse

Tension

pneomothorax

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Tension

pneomothorax

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Needle

toracostomy

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Needle Decompression

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nEEDLE

tHoracostomy

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* Flail

chest occurs when TWO

or more contiguous ribs are fractured in at least

two location* additional

work of breathing and chest wall

pain

caused by the flail segment is sufficient to compromise

ventilation* it is the decreased compliance and increased shunt fraction caused by the associated pulmonary contusion that is typically the source of post injury pulmonary dysfunction* Treatment is intubation and mechanical ventilation (PEEP

mode)

The

patient's initial chest radiograph often underestimates the extent of the pulmonary parenchymal damage

Must chest tube if bleeding

!Flail chest

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Flail chest

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Flail chest

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life-threatening

injury number one

A

massive hemothorax is defined as >1500 mL

of blood or, in the

pediatric

population,

one third of the patient's blood volume in the pleural space tube thoracostomy is the only reliable means to quantify the amount of hemothoraxAfter blunt trauma, a hemothorax usually is due to multiple rib fractures

occasionally bleeding is from lacerated lung

parenchyma

a

massive

hemothorax is an indication for operative interventionIndication of emergency toracotomyhemothorax

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hemothorax

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Hemothorax

Physical Findings

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Rib fracture with

hemothorax

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Rib fracture with

hemothorax

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life-threatening

injury number two

Acutely, <

100 mL of pericardial blood may cause pericardial tamponadeThe classic diagnostic

Beck's triad

—dilated neck veins, muffled heart tones, and a decline in arterial pressure

—often is not observed in the trauma

Increased intrapericardial pressure also impedes myocardial blood flow, which leads to subendocardial ischemiaBest way to diagnose is ultrasound of the pericardium Early in the course of

tamponade

fluid administration

a pericardial drain is placed using ultrasound guidance

Pericardiocentesis

is successful in decompressing

tamponade in approximately 80% of cases : 15 to 20 ccCardiac tamponade

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Cardiac

tamponade

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BECKS

tRIAD

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Pericardial

Tamponade

Physical Findings

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Pericardiocentesis

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