This document provides information on assessing and managing chest trauma. It discusses inspecting, palpating and auscultating the chest to evaluate respiratory status. Tension pneumothorax is described as a life-threatening condition requiring immediate needle decompression. Chest trauma management focuses on treating respiratory distress from rib fractures, pneumothorax and pulmonary contusion, as well as hemorrhagic shock. Special considerations for open pneumothorax and pregnancy are also covered.

1. PTC
1
BREATHING
(VENTILATION)

2. PTC
2
ASSESSMENT
 Inspection (LOOK)
 Palpation (FEEL)
 Auscultation (LISTEN)
 Resuscitate

3. PTC
3
INSPECTION
Respiratory rate
Accessory muscle use
Cyanosis
Penetrating injury
Flail chest
Sucking chest wound

4. PTC
4
PALPATION
Tracheal shift
Rib fractures
Subcutaneous emphysema
Percussion

5. PTC
5
AUSCULTATION
Breath sounds
Heart sounds
Bowel sounds

6. PTC
6
TENSION PNEUMOTHORAX
Respiratory distress
Tachycardia
Hypotension
Distended neck veins
Resonant percussion note
Tracheal deviation
 Air entry

7. PTC
7
TENSION PNEUMOTHORAX
MANAGEMENT
 Immediate decompression
 Large bore needle
 Second intercostal space
 Mid clavicular line
 Formal chest drain to follow

8. PTC
8
TENSION PNEUMOTHORAX
Should be a clinical diagnosis
Treat before X-ray

9. PTC
9
CHEST TRAUMA

10. PTC
10
CHEST TRAUMA
 Cause of ~25% of trauma deaths
 Immediate deaths due to major disruption of
heart and great vessels
 Early deaths due to airway obstruction,
cardiac tamponade or aspiration

11. PTC
11
CHEST TRAUMA
RESPIRATORY DISTRESS
 Rib fractures/flail chest
 Pneumothorax (simple, tension, open)
 Haemothorax
 Pulmonary contusion
 Aspiration

12. PTC
12
CHEST TRAUMA
HAEMORRHAGIC SHOCK
Haemothorax
Haemomediastinum
BEWARE HIDDEN HAEMORRHAGE

13. PTC
13
CHEST TRAUMA
RIB FRACTURES
 May occur at point of impact
 Often associated with pulmonary
contusion
 May result from simple trauma in the
elderly
 Remember analgesia

14. PTC
14
CHEST TRAUMA
FLAIL CHEST
 Ventilation  due to pain, contusion and
compromised respiratory mechanics
 Adequate analgesia is vital
 Give oxygen (if available)
 Consider intubation and IPPV

15. PTC
15
CHEST TRAUMA
TENSION PNEUMOTHORAX
 Air enters the pleural space but cannot leave
 Intrathoracic pressure resulting in mediastinal
shift,  VR and  CO
 Respiratory distress and hypoxia follow

16. PTC
16
CHEST TRAUMA
TENSION PNEUMOTHORAX
LIFE THREATENING EMERGENCY
CLINICAL DIAGNOSIS
URGENT DECOMPRESSION
ESSENTIAL

17. PTC
17
TENSION PNEUMOTHORAX
 respiratory distress
 tachycardia
 hypotension
 distended neck veins
 resonant percussion note
 tracheal deviation
  air entry

18. PTC
18
TENSION PNEUMOTHORAX
MANAGEMENT
 Immediate decompression
 Large bore needle
 Second intercostal space
 Mid clavicular line
 Formal chest drain to follow

19. PTC
19
CHEST TRAUMA
SIMPLE PNEUMOTHORAX
Any pneumothorax must be treated prior to
PPV to prevent occurrence of a tension
pneumothorax.

20. PTC
20
CHEST TRAUMA HAEMOTHORAX
 More common in penetrating than in blunt
trauma
 Hypovolaemic shock may occur
 Large bore chest tube will drain blood and
tamponade any bleeding chest wall vessels
 Consider thoracotomy if bleeding continues >
200-300 ml/hr

21. PTC
21
CHEST TRAUMA
PULMONARY CONTUSION
 Potentially life threatening
 Occurs with blunt and penetrating
trauma
 Suspect if rib fractures
 Onset often slow and progressive over 24
hours

22. PTC
22
CHEST TRAUMA
OPEN PNEUMOTHORAX
 “Sucking” chest wound
 Other signs of pneumothorax present
 Occlude wound (on 3 sides only) to permit
air to escape on expiration
 Urgent insertion of chest drain

23. PTC
23
CHEST TRAUMA
MYOCARDIAL CONTUSION
 Contusion is common in blunt trauma
 Contusion can mimic myocardial infarction
 Can cause sudden death after the accident
 ECG monitoring (if available)

24. PTC
24
CHEST TRAUMA
OTHER INJURIES
Pericardial tamponade
Great vessel injury
Airway rupture
Oesophageal trauma
Diaphragmatic injury

25. PTC
PERICARDIAL TAMPONADE
 Clinically apparent cardiac tamponade may
result from 60-100 ml of blood:
 BECK’S TAMPONADE TRIAD:
- Hypotension
- JVD
_ Muffled heart sounds
 Mx: Needle pericardiocentesis (decompression)
25

26. PTC
26
TRAUMA IN PREGNANCY

27. PTC
27
THE PREGNANT PATIENT
 Important anatomical and physiological
considerations
 Resuscitation of the mother is also
resuscitation of the foetus
 Mother comes first
TRAUMA MANAGEMENT
PRINCIPLES ARE THE SAME

28. PTC
28
ANATOMICAL CHANGES
FUNDAL HEIGHT
12 weeks symphysis pubis
20 weeks umbilicus
36 weeks xiphoid

29. PTC
29
PHYSIOLOGICAL CHANGES
  tidal volume and respiratory alkalosis
 Cardiac output  30%
 Blood volume  40%
 BP  15mmHg in second trimester
 HR  10-15
 Prone to aortocaval compression

30. PTC
30
SPECIAL ISSUES
 Uterine irritability and premature
labour
 Rupture of uterus (partial or complete)
 Placental separation
 Pelvic fractures may result in severe
blood loss

31. PTC
31
MANAGEMENT PRIORITIES
 ABCDE of mother
 Left lateral tilt
 Vaginal examination
 Mark fundal height
 Look for fundal tenderness
 Monitor foetal heart rate