Chest Trauma Qutaibah oudat jordan
Introduction <ul><li>Chest trauma is often sudden and dramatic </li></ul><ul><li>Accounts for 25% of all trauma deaths </l...
Mechanism of Injury <ul><li>Penetrating injuries </li></ul><ul><li>E.g. stab wounds etc. </li></ul><ul><li>Haemothorax </l...
Chest Wall Injuries  <ul><li>Rib fractures  </li></ul><ul><li>Flail chest </li></ul><ul><li>Open pneumothorax </li></ul>
<ul><li>Rib fracture is the most common significant of blunt thoracic trauma: </li></ul><ul><li>Markers of serious intrath...
Rib Fracture <ul><li>3 rd -9 th  ribs associated with : </li></ul><ul><li>Blunt trauma. </li></ul><ul><li>Underlying lung ...
Rib fractures <ul><li>Signs & Symptoms: </li></ul><ul><li>Localised pain, tenderness, crepitus </li></ul><ul><li>Diagnosti...
Flail chest <ul><li>Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration. </li></ul...
Flail chest
Flail Chest - detail
Lung injury <ul><li>Pneumothorax  </li></ul><ul><li>Haemothorax </li></ul><ul><li>Trachea and bronchial injuries </li></ul...
Pneumothorax <ul><li>accumulation of Air or Gas between the (pleural cavity) parietal and visceral pleurae, leading to lun...
Causes <ul><li>Closed pneumothorax: </li></ul><ul><li>barotrauma. </li></ul>
S & S <ul><li>Unilateral signs:   </li></ul><ul><li>a.  movement and breath sounds, </li></ul><ul><li>b. resonant to perc...
Pneumothorax
 
Open Pneumothorax <ul><li>Defect in chest wall provides a direct communication between the pleural space and the environme...
Tension Pneumothorax  <ul><li>Air accumulates intrapleurally and can’t escape. </li></ul><ul><li>Air enters pleural space ...
Causes of  Tension Pneumothorax   <ul><li>Chest tube occlusion or malfunction. </li></ul><ul><li>High positive end-expirat...
Continue….. <ul><li>P/C:   </li></ul><ul><li>chest pain. </li></ul><ul><li>dyspnoea </li></ul><ul><li>Dx:   </li></ul><ul>...
<ul><li>Surgical emergency </li></ul><ul><li>Rx: emergency decompression before CXR </li></ul><ul><li>Either large bore ca...
Haemothorax <ul><li>Blunt or penetrating trauma </li></ul><ul><li>Requires rapid decompression and fluid resuscitation </l...
Chest trauma: summary <ul><li>Common </li></ul><ul><li>Serious </li></ul><ul><li>Primary goal is to provide oxygen to vita...
Continue….. <ul><li>ALERT If the patient’s chest tube dislodges, immediately place a petroleum gauze dressing over the ope...
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Chest trauma nur 415-fall 2009

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Chest trauma nur 415-fall 2009

  1. 1. Chest Trauma Qutaibah oudat jordan
  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>Associated with high mortality rate. </li></ul><ul><li>Serious pathological consequnces: -hypoxia, hypovolemia, 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>Haemothorax </li></ul><ul><li>Pneumothorax </li></ul><ul><li>Cardiac, great vessel or oesophageal injury. </li></ul><ul><li>Great vessel injuries leads to death. </li></ul><ul><li>Early deaths occur (30 min-3 hrs after trauma. </li></ul><ul><li>Blunt injuries Either : - direct blow (e.g. rib fracture). </li></ul><ul><li>- compression injury. </li></ul>
  4. 4. Chest Wall Injuries <ul><li>Rib fractures </li></ul><ul><li>Flail chest </li></ul><ul><li>Open pneumothorax </li></ul>
  5. 5. <ul><li>Rib fracture is the most common significant of blunt thoracic trauma: </li></ul><ul><li>Markers of serious intrathorasic & abdominal injuries. </li></ul><ul><li>Source of significant pain. </li></ul><ul><li>Predictor of pulmonary deterioration. </li></ul><ul><li>Fracture of scapula, sternum, or ribs. </li></ul><ul><li>1 st -2nd rib # suggests massive force of injury or trauma. </li></ul>
  6. 6. Rib Fracture <ul><li>3 rd -9 th ribs associated with : </li></ul><ul><li>Blunt trauma. </li></ul><ul><li>Underlying lung injury. </li></ul><ul><li>Lower ribs associated with: </li></ul><ul><li>Injury to liver. </li></ul><ul><li>Injury to abdomen. </li></ul><ul><li>Upper ribs, clavicle or scapula fracture: suspect vascular injury </li></ul>
  7. 7. Rib fractures <ul><li>Signs & Symptoms: </li></ul><ul><li>Localised pain, tenderness, crepitus </li></ul><ul><li>Diagnostic Procedure: </li></ul><ul><li>CXR to exclude other injuries </li></ul><ul><li>Management : </li></ul><ul><li>Air way management. </li></ul><ul><li>Pain management (analgesia & avoid taping). </li></ul><ul><li>Nurse must consider underlying structure and injury to them. </li></ul>
  8. 8. Flail chest <ul><li>Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration. </li></ul><ul><li>Significant force required to cause # of multiple ribs. </li></ul><ul><li>usually Sternal # is present. </li></ul><ul><li>Usually diagnosed clinically </li></ul><ul><li>Rx : </li></ul><ul><li>ABC . </li></ul><ul><li>Analgesia. </li></ul><ul><li>Turn pt from side to side down to improve oxygenation . </li></ul><ul><li>Internal splitting used. </li></ul>
  9. 9. Flail chest
  10. 10. Flail Chest - detail
  11. 11. Lung injury <ul><li>Pneumothorax </li></ul><ul><li>Haemothorax </li></ul><ul><li>Trachea and bronchial injuries </li></ul><ul><li>Pneumomediastinum </li></ul>
  12. 12. Pneumothorax <ul><li>accumulation of Air or Gas between the (pleural cavity) parietal and visceral pleurae, leading to lung collapse. </li></ul><ul><li>Blunt or penetrating injury that disrupts the parietal or visceral pleura. </li></ul><ul><li>Degree of lung collapse determined by amount of trapped air or gas. </li></ul><ul><li>Most common types: open, closed, and tension. </li></ul>
  13. 13. Causes <ul><li>Closed pneumothorax: </li></ul><ul><li>barotrauma. </li></ul>
  14. 14. S & S <ul><li>Unilateral signs: </li></ul><ul><li>a.  movement and breath sounds, </li></ul><ul><li>b. resonant to percussion </li></ul><ul><li>Diagnostic Procedure: </li></ul><ul><li>Confirmed by CXR </li></ul><ul><li>Rx: </li></ul><ul><li>chest drain </li></ul>
  15. 15. Pneumothorax
  16. 17. 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>Causes: </li></ul><ul><li>Central venous catheter insertion. </li></ul><ul><li>Chest surgery. </li></ul><ul><li>Penetrating chest injury. </li></ul><ul><li>Thoracentesis. </li></ul><ul><li>Percutaneous Lung Biopsy </li></ul><ul><li>Rx: </li></ul><ul><li>ABCs. </li></ul><ul><li>closure of wound. </li></ul><ul><li>chest drain. </li></ul>
  17. 18. Tension Pneumothorax <ul><li>Air accumulates intrapleurally and can’t escape. </li></ul><ul><li>Air enters pleural space and cannot escape. </li></ul><ul><li>On Inspiration: </li></ul><ul><li>Increasing intrathorasic pressure cause the mediastinum to shift toward the unaffected lung, impairing ventilation. </li></ul><ul><li>On Expiration: </li></ul><ul><li>The mediastinal shift distorts the vena cava and reduce venous return, producing hypotension and shock. </li></ul>
  18. 19. Causes of Tension Pneumothorax <ul><li>Chest tube occlusion or malfunction. </li></ul><ul><li>High positive end-expiratory pressures, causing rupture of alveolar blebs. </li></ul><ul><li>Lung or airway puncture from positive-pressure ventilation. </li></ul><ul><li>Mechanical ventilation after chest injury. </li></ul><ul><li>Penetrating chest wound. </li></ul>
  19. 20. Continue….. <ul><li>P/C: </li></ul><ul><li>chest pain. </li></ul><ul><li>dyspnoea </li></ul><ul><li>Dx: </li></ul><ul><li>Respiratory distress symptoms. </li></ul><ul><li>Tracheal deviation (away) </li></ul><ul><li>Absence of breath sounds </li></ul><ul><li>Distended neck veins </li></ul><ul><li>Hypotension </li></ul>
  20. 21. <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>
  21. 22. 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>
  22. 23. 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>
  23. 24. Continue….. <ul><li>ALERT If the patient’s chest tube dislodges, immediately place a petroleum gauze dressing over the opening. </li></ul><ul><li>ALERT Watch for signs and symptoms of tension pneumothorax, which can be fatal. these include anxiety, hypotension, tachycardia, tachypnea, and cyanosis. </li></ul>
  24. 25. Thanks

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