Chest Trauma

2,474 views
2,403 views

Published on

Published in: Health & Medicine
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,474
On SlideShare
0
From Embeds
0
Number of Embeds
6
Actions
Shares
0
Downloads
182
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Chest Trauma

  1. 1. Chest Trauma Gráinne Murphy Final Med April 2002
  2. 2. Introduction <ul><li>Chest trauma is often sudden and dramatic </li></ul><ul><li>Accounts for 25% of all trauma deaths </li></ul><ul><li>2/3 of deaths occur after reaching hospital </li></ul><ul><li>Serious pathological consequnces: -hypoxia, hypovolaemia, myocardial failure </li></ul>
  3. 3. Mechanism of Injury <ul><li>Penetrating injuries </li></ul><ul><li>E.g. stab wounds etc. </li></ul><ul><li>Primarily peripheral lung </li></ul><ul><li>Haemothorax </li></ul><ul><li>Pneumothorax </li></ul><ul><li>Cardiac, great vessel or oesophageal injury </li></ul>
  4. 4. <ul><li>Either: - direct blow (e.g. rib fracture) - deceleration injury or - compression injury </li></ul><ul><li>Rib fracture is the most common sign of blunt thoracic trauma </li></ul><ul><li>Fracture of scapula, sternum, or first rib suggests massive force of injury </li></ul>Blunt injuries
  5. 5. Chest wall injuries <ul><li>Rib fractures </li></ul><ul><li>Flail chest </li></ul><ul><li>Open pneumothorax </li></ul>
  6. 6. Rib fractures <ul><li>Most common thoracic injury </li></ul><ul><li>Localised pain, tenderness, crepitus </li></ul><ul><li>CXR to exclude other injuries </li></ul><ul><li>Analgesia..avoid taping </li></ul><ul><li>Underestimation of effect </li></ul><ul><li>Upper ribs, clavicle or scapula fracture: suspect vascular injury </li></ul>
  7. 7. Flail chest <ul><li>Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration </li></ul><ul><li>Significant force required </li></ul><ul><li>Usually diagnosed clinically </li></ul><ul><li>Rx: ABC Analgesia </li></ul>
  8. 8. Flail chest
  9. 9. Flail Chest - detail
  10. 10. Open pneumothorax <ul><li>Defect in chest wall provides a direct communication between the pleural space and the environment </li></ul><ul><li>Lung collapse and paroxysmal shifting of mediastinum with each respiratory effort ± tension pneumothorax </li></ul><ul><li>“ Sucking chest wound” </li></ul><ul><li>Rx: ABCs…closure of wound…chest drain </li></ul>
  11. 11. Lung injury <ul><li>Pulmonary contusion </li></ul><ul><li>Pneumothorax </li></ul><ul><li>Haemothorax </li></ul><ul><li>Parenchymal injury </li></ul><ul><li>Trachea and bronchial injuries </li></ul><ul><li>Pneumomediastinum </li></ul>
  12. 12. Pneumothorax <ul><li>Air in the pleural cavity </li></ul><ul><li>Blunt or penetrating injury that disrupts the parietal or visceral pleura </li></ul><ul><li>Unilateral signs:  movement and breath sounds, resonant to percussion </li></ul><ul><li>Confirmed by CXR </li></ul><ul><li>Rx: chest drain </li></ul>
  13. 13. Pneumothorax
  14. 14. Tension pneumothorax <ul><li>Air enters pleural space and cannot escape </li></ul><ul><li>P/C: chest pain, dyspnoea </li></ul><ul><li>Dx: - respiratory distress - tracheal deviation (away) - absence of breath sounds - distended neck veins - hypotension </li></ul>
  15. 15. <ul><li>Surgical emergency </li></ul><ul><li>Rx: emergency decompression before CXR </li></ul><ul><li>Either large bore cannula in 2nd ICS, MCL or insert chest tube </li></ul><ul><li>CXR to confirm site of insertion </li></ul>
  16. 16. Haemothorax <ul><li>Blunt or penetrating trauma </li></ul><ul><li>Requires rapid decompression and fluid resuscitation </li></ul><ul><li>May require surgical intervention </li></ul><ul><li>Clinically: hypovolaemia absence of breath sounds dullness to percussion </li></ul><ul><li>CXR may be confused with collapse </li></ul>
  17. 17. Heart, Aorta & Diaphragm <ul><li>Blunt cardiac injury - contusion - ventricular, septal or valvular rupture </li></ul><ul><li>Cardiac tamponade </li></ul><ul><li>Ruptured thoracic aorta </li></ul><ul><li>Diaphragmatic rupture </li></ul>
  18. 18. Cardiac Tamponade <ul><li>Blood in the pericardial sac </li></ul><ul><li>Most frequently penetrating injuries </li></ul><ul><li>Shock,  JVP, PEA, pulsus paradoxus </li></ul><ul><li>Classically, Beck’s triad: - distended neck veins - muffled heart sounds - hypotension </li></ul><ul><li>Rx: Volume resuscitation Pericardiocentesis </li></ul>
  19. 19. Cardiac tamponade
  20. 20. Aortic rupture <ul><li>Usually blunt trauma involving deceleration forces; especially RTAs </li></ul><ul><li>~90% die within minutes </li></ul><ul><li>Most common site near ligamentum arteriosum </li></ul><ul><li>Dx: clinical suspicion, CXR, aortography, contrast CT or TOE </li></ul><ul><li>Rx: surgical…poor prognosis </li></ul>
  21. 21. Aortic rupture
  22. 22. Iatrogenic trauma <ul><li>NG tubes: -coiling -endobronchial placement -pneumothorax </li></ul><ul><li>Chest tubes: - subcutaneous - intraparenchymal - intrafissural </li></ul><ul><li>Central lines: - neck - coronary sinus - pneumothorax </li></ul>
  23. 23. Line in jugular vein
  24. 24. Misplaced nasogastric tube
  25. 25. Chest trauma: summary <ul><li>Common </li></ul><ul><li>Serious </li></ul><ul><li>Primary goal is to provide oxygen to vital organs </li></ul><ul><li>Remember A irway B reathing C irculation </li></ul><ul><li>Be alert to change in clinical condition </li></ul>

×