CHEST TRAUMA BY SAMUEL ASUEME

1. Chest TraumaChest Trauma
HAEMOTHORAXHAEMOTHORAX

2. Frequency of Various InjuriesFrequency of Various Injuries
In Motor Vehicle AccidentsIn Motor Vehicle Accidents
ExtremitiesExtremities 34%34%
Head and neckHead and neck 32%32%
ChestChest 25%25%
AbdomenAbdomen 15%15%

3. Mechanism of InjuryMechanism of Injury
in Chest Traumain Chest Trauma
 Acceleration/deceleration (motor vehicle accident)Acceleration/deceleration (motor vehicle accident)
 Body compression (crush injury)Body compression (crush injury)
 High-speed impact (gunshot wound)High-speed impact (gunshot wound)
 MiscellaneousMiscellaneous
Low-velocity penetration (stab wound)Low-velocity penetration (stab wound)
Airway obstruction (suffocation)Airway obstruction (suffocation)
Caustic injury (poisoning)Caustic injury (poisoning)
BurnsBurns
ElectrocutionElectrocution

4. Percentage of Specific Types ofPercentage of Specific Types of
Thoracic Organ InjuryThoracic Organ Injury
Chest wallChest wall 5454
Flail chestFlail chest 1313
PneumothoraxPneumothorax 2020
HemothoraxHemothorax 2121
PulmonaryPulmonary 2121
MiscellaneousMiscellaneous 1818

5. Monitoring and evaluating the patientMonitoring and evaluating the patient
with Thoracic traumawith Thoracic trauma
 Roentgenograms of the thorax (Chest wallRoentgenograms of the thorax (Chest wall
i.e. ribs, sternum, vertebral, clavicles).i.e. ribs, sternum, vertebral, clavicles).
 Mediastmum (wide or normal) shiftedMediastmum (wide or normal) shifted
or not.or not.
 Lung parenchyma (Contusion).Lung parenchyma (Contusion).
 The heart (cardiac tamponade).The heart (cardiac tamponade).
 Diaphragm.Diaphragm.
 Pneumothorax, hemothorax.Pneumothorax, hemothorax.
 ECGECG
 CVPCVP
 Arterial blood gases.Arterial blood gases.
 Urine output.Urine output.
 Lab. Investigations.Lab. Investigations.
 Others.Others.

6.  The treatment of polytraumatized patient must follow aThe treatment of polytraumatized patient must follow a
certain protocol which includes.certain protocol which includes.
 Adequate oxygenation.Adequate oxygenation.
 Fluid replacement.Fluid replacement.
 Surgical intervention.Surgical intervention.
 Treatment of septic complications.Treatment of septic complications.
 Adequate caloric and substrate supplementation.Adequate caloric and substrate supplementation.
 Prevention of stress bleeding.Prevention of stress bleeding.
 Finally, be alert of possible complication (CNS, ARDS,Finally, be alert of possible complication (CNS, ARDS,
hepatic, renal, coagulation disorders, sepsis.hepatic, renal, coagulation disorders, sepsis.
Management of patients withManagement of patients with
Thoracic TraumaThoracic Trauma

7. Flail ChestFlail Chest

8. Pneumothorax andPneumothorax and HemothoraxHemothorax
 Cases of pneumothorax and hemothorax can beCases of pneumothorax and hemothorax can be
provided with extremely effective therapy for theprovided with extremely effective therapy for the
most part with simple methods, in more than 80% ofmost part with simple methods, in more than 80% of
cases.cases.
 It must, however, be given early, furthermore theIt must, however, be given early, furthermore the
drainage of air and blood must be efficient.drainage of air and blood must be efficient.

9. HemothoraxHemothorax
DiagnosisDiagnosis
 Diminished breath sound.Diminished breath sound.
 Muffled sound on percussion.Muffled sound on percussion.
 X-ray chest: Clouding of the affected half of theX-ray chest: Clouding of the affected half of the
thorax up to complete opacity.thorax up to complete opacity.
In the diagnosis of hemothorax formation ofIn the diagnosis of hemothorax formation of
atelectosis and rupture of the diaphragm should beatelectosis and rupture of the diaphragm should be
differentiated.differentiated.

10. Sources of blood accumulating in the chestSources of blood accumulating in the chest
following blunt or penetrating trauma:following blunt or penetrating trauma:
 Pulmonary parenchymal laceration.Pulmonary parenchymal laceration.
 Rupture of pleural adhesions.Rupture of pleural adhesions.
 Mediastinal injury with or without vascular injury.Mediastinal injury with or without vascular injury.
 Cardiac injury with pericardio-pleuralCardiac injury with pericardio-pleural
communication.communication.
 Decompression of abdominal hemorrhage through aDecompression of abdominal hemorrhage through a
traumatic diaphragmatic injury.traumatic diaphragmatic injury.
HemothoraxHemothorax

11. TherapyTherapy
 The key to successful management of acuteThe key to successful management of acute
hemothorax is early aggressive care in the form ofhemothorax is early aggressive care in the form of
adequate pleural evacuation by thoracostomy oradequate pleural evacuation by thoracostomy or
thoracotomy in order to minimize the morbidity.thoracotomy in order to minimize the morbidity.
 The rate and cessation of bleeding depends on theThe rate and cessation of bleeding depends on the
site and size of the bleeding wound.site and size of the bleeding wound.
HemothoraxHemothorax

12.  Thoracotomy is done if the bleeding is constant andThoracotomy is done if the bleeding is constant and
more than 300 ml per hour during the first three tomore than 300 ml per hour during the first three to
four hours. However, tube thoracotomy is all what isfour hours. However, tube thoracotomy is all what is
needed if bleeding is less and decreasing withoutneeded if bleeding is less and decreasing without
radiological evidence of clotted blood.radiological evidence of clotted blood.
HemothoraxHemothorax

13. Incision overIncision over
intercostal spaceintercostal space
Development of
subcutaneous tract
Penetration of
parietal pleura
Insertion of Chest TubeInsertion of Chest Tube
Confirmation that lung is not
adherent to chest wall at
puncture site