there is the introduction part of the torso trauma,
check out my next ppts for further more about torso trauma.
contents are in following order...
introduction
mechanism of injury
junctional zones of torso
tension pneumothorax
cardiac temponade
massive hemothorax
etc.
check out all slides
3. INTRODUCTION
Rapid accumulation of greater than 1500 ml or 1/3rd blood
volume in Pleural cavity.
A massive hemothorax is defined as blood drainage ≥1500
ml after closed thoracostomy and continuous bleeding at
200 ml/ hour for at least 3 to 4 hours.
5. 1. Traumatic hemothorax (Usually from blunt
trauma or penetrating trauma resulting in
vascular injuries to):
â—Ź Chest wall and associated structures,
â—Ź Blood vessels, and
â—Ź Lung (rare)
6. In blunt injury
1. Continuing bleeding from torn intercostal vessels or
2. Occasionally from the internal mammary artery and,
3. Secondary to fractures of the ribs
CHEST WALL AND ASSOCIATED STRUCTURES
7. In penetrating injury
A variety of viscera, both thoracic and abdominal (with
blood leaking through a hole in the diaphragm from
the positive pressure abdomen into the negative
pressure thorax) may be involved.
8. BLOOD VESSELS
â—Ź Aorta and brachiocephalic Arteries
â—Ź SVC, IVC, brachiocephalic veins
â—Ź Pulmonary arteries and veins
LUNG
â—Ź Lung parenchymal injury
â—Ź low pulmonary arterial pressure + compressing effect of
blood in pleural space limit bleeding
9. 2. Iatrogenic hemothorax
Central venous catheterization or thoracostomy tube
placement
3. Spontaneous/disease complications
Tuberculosis, pulmonary embolism, Coagulopathy,
neoplasia, thoracic aortic dissection or aneurysm
LESS COMMON ETIOLOGIES
10. Trauma to the thoracic cavity leads to bleeding and subsequent
blood pooling in the pleural cavity
PATHOGENESIS
interferes with normal movement of the lungs by preventing
normal expansion of the lungs
11. â—Ź Mainly altered cardiac and respiratory functions
â—Ź Influenced by amount and rate of blood loss
â—Ź Large clots in pleural space release fibrinolysins leading to
further bleeding
â—Ź Residual hemothorax increases osmotic pressure
â—Ź Leads to fluid transudation and increases pleural fluid
volume
Cont…
12. â—Ź Each hemithorax can hold 40-
50% of circulating blood
volume
â—Ź Blood can accumulate rapidly
in pleural space
â—Ź Decreases preload
â—Ź Compromises LV function and
cardiac output
LIFE-THREATENING BY 3
MECHANISMS
â—Ź Compresses venacava
â—‹ Decreases preload
â—Ź Compresses lung parenchyma
â—‹ Increases vascular
resistance
â—Ź From lung collapse
â—Ź alveolar hypoventilation
ACUTE HYPOVOLEMIA HYPOXIA PRESSURE OF HEMOTHORAX
13. â—Ź Motor vehicle collisions (MVCs) represents the most
common cause of major thoracic injuries.
â—Ź Hemothorax related to trauma around 300,000
cases/year
â—Ź 60-70% in blunt chest trauma
â—Ź 50-60% in penetrating trauma
â—Ź Incidence of hemothorax and pneumothorax increases
with number of ribs fracture
EPIDEMIOLOGY
INCIDENCE/PREVALENCE
15. INSPECTION: asymmetrical Chest movement with
respiration (at the affected side) , flat neck veins
PALPATION: Tenderness, trachea might be shifted (if
massive bleeding causes mediastinal shift)
PERCUSSION: dullness at the Affected side
AUSCULTATION: decreased or absent breath sound
SIGNS
18. Management of massive hemothorax
Volume
Replacement
Chest
decompression
Correcting the
hypovolaemic shock
Insertion of an
intercostal drain
19. INTERCOSTAL CHEST TUBE INSERTION(ICT)
Indication : Pneumothorax, hemothorax, pleural effusion
Size of ICT - Large bore 24 - 36 F
SITE - ICS 4th or 5th at mid axillary line
Triangle of safety
21. CHEST X RAY (bedside)
Portable supine
â—Ź May show only general
haziness or opacification of
affected lung field, even
with 1 L of blood in
hemithorax
â—Ź Look for rib fractures
â—Ź May see tracheal deviation
Upright (best for primary
imaging)
â—Ź Blunting of costophrenic
angle equate to 400-500 mL
of blood
â—Ź Air-fluid interface seen if
hemopneumothorax.
23. Ultrasound (bedside)
â—Ź Use as part of FAST and as adjunct with
CXR
â—Ź Shows fluid between chest wall and lung for
hemothorax
â—Ź With penetrating trauma, provides info on
pericardial involvement
â—Ź Greater sensitivity and equal specificity
than CXR
24. CT SCAN
â—Ź Use if CXR ambiguous or initial treatment
fails
â—Ź Highest sensitivity and specificity for
hemothorax
â—Ź More sensitive for localization of clots,
loculated collections
28. PROGNOSIS
Mortality/Morbidity
Thoracic injuries responsible for 20-25% of all trauma-related deaths
15% of those with chest trauma need thoracotomy
Risk factors for mortality among blunt trauma patients
â—Ź Age > 64 years old
â—Ź > 2 rib fractures
Pre-existing disease, especially cardiopulmonary.