Chest injuries...

1. Chest injuries
YASIR HUSSAIN
GROUP 115

2. INTRODUCTION
►The chest contains vital organs.
►Damage to vital organs threatens life.
►Most common consequence is hypoxia.
►Chest injuries result in a significant number of
deaths each year.
►One in every 4 cases of trauma death caused by
chest injury.

3. *Chest injuries can be divided into:
-Immediate life threatening injuries
-Potentially life threatening injuries

4. Immediate life threatening injuries
Injuries that can cause death in a matter of minutes
and, therefore, must be identified and treated during
the initial evaluation and resuscitation.

5. • Airway obstruction
• Tension pneumothorax
• Open pneumothorax
• Massive heamothorax
• Cardiac tamponad
• Flial chest

6. Potentially life threatening injuries
Injuries that, left untreated, would likely result in death
but that usually allow several hours to establish a
definitive diagnosis and institute appropriate treatment

7. • Traumatic aortic rupture.
• Myocardial contusion.
• Tracheal bronchial injury.
• Rupture diaphragm.
• Esophageal trauma.
• Pulmonary contusion.

8. ►Mechanism of injury :
►
1) Blunt chest trauma
 Most common cause of serious chest injuries.
 Post RTA, falls, direct blows, and crushing injuries.
 Many injuries are not immediately apparent
in physical exam.
2) Penetrating trauma
 Immediate result can be severe bleeding or impaired
breathing.
 Any chest wound can involve underlying organ injury.
 No matter how superficial it looks.
 Injuries to the heart, lungs, and great vessels can
quickly lead to shock and cardiac arrest.
3) Iatrogenic

9. ►Signs and symptoms:
• Most common symptoms: pain and difficulty
breathing.
• Signs are obvious injury to the chest wall (
looking at both the front and back of the chest).
• Note any subcutaneous emphysema, or air
present under the skin
►Assessment:
Follow all steps in the assessment of the trauma
patient:
• Primary survey( A. Airway B. Breathing C.
Circulation).
• Resuscitation.
• Detailed secondary survey (CXR , ABG ,ECG , CT
Chest , Aortogram).

10. ►Management
• Ensure patient has adequate oxygenation and
perfusion
• Provide high-flow oxygen, ventilating when
necessary
• Halt any obvious bleeding
• Support circulation when needed
• Rapidly transport patient to definitive care

11. Rib fracture
• Simple rib fractures are the most common injury
sustained following blunt chest trauma
• More common in adults than children.
• The most common mechanism of injury for rib
fractures in elderly persons is a fall from height or
from standing. In adults, motor vehicle accident
(MVA) is the most common mechanism.

12. ►Ribs commonly fracture at the point of impact
or at the posterior angle (structurally their
weakest area(.
►Ribs four through nine (4-9) are the most
commonly injured.

14. Signs and Symptoms:
►Pain when breathing or with movement
►Patient often presents with guarding and
shallow breathing
►Chest wall instability
►Deformity, discoloration
►Local swelling and tenderness may be the
only sing of broken rib

15. Complication s of rib fracture:
►Chronic chest pain
►Lung contusion
►Pneumo or hemothorax
►Injury to aorta or bronci
►Flail chest
►Fracture of the 8th to 12th ribs can damage
underlying abdominal solid organs:
liver, spleen or kidneyes

16. Management:
• Move the patient carefully to prevent the
bone ends from puncturing the lung.
• Administer O2.
• Allow patient to self-splint by assuming the
most comfortable position possible.
• Encourage patient to limit movement.
• Analgesia like Morphine, PCA, Epidural.
• Evaluation: hx, px and tests (CBC, CXR and
MRI)

17. FLAIL CHEST
Blunt chest trauma, causing extensive anterior and
posterior rib fractures or sternocostal disconnection,
results in paradoxical chest wall movement

19. Management:
►Adequate pain control
►Quickly stabilize flial segment by placing gloved
hand over injured area
►After manual stabilization, place folded
universal dressing over segment and tape
securely.
►Fixation (external, internal)
►Chest tube as required
►Mechanical ventilation may be required in
severe cases.

20. Paradoxical chest movement

21. Post Traumatic
Pneumothorax
►Types:
Opened pneumothorax.
Close pneumothorax.

22. Open Pneumothorax
An injury in which an open wound in the chest wall
has exposed the pleura space to the atmosphere.
The open wound allows air movement through the
defect during spontaneous respiration, causing
ineffective alveolar ventilation.

24. Signs:
►difficulty breathing
►Cyanosis
►Diminished breath sounds on the affected side

25. Management:
►Cover open chest wounds with occlusive dressing
and inserting a thoracostomy tube
►Gloved hand is an effective temporary occlusive
dressing
►High flow oxygen
►Transport with unaffected side slightly elevated
►Later closure of the wound may be necessary

26. Tension Pneumothorax
• Potentially life-threatening condition that must be
treated immediately.
• Can occur in blunt or penetrating chest trauma.

30. What Happen in Tension Pneumothorax
►One-way valve forms in lung or chest wall
►Air enters pleural space; cannot leave
►Air is trapped in pleural space
►Pressure rises
►Pressure collapses lung
►Shifting of the mediastinum to the contralateral
side, which compreses the vena cava and
obstructs venous return to the heart.

31. Signs and Symptoms
• Extreme dyspnea
• Restlessness, anxiety, agitation
• Decreased breath sounds
• Hyperresonance to percussion
• Cyanosis
• Subcutaneous emphysema
• Rapid, weak pulse
• Decreased BP
• Tracheal shift away from injured side
• Jugular vein distension
• Early dyspnea/hypoxia - Late shock

32. Management:
The thorax must be decompressed with a needle,
which is replaced by an intercostal tube with
underwater seal and suction.

33. Hemothorax
► Blood in the pleural space .
► Most common result of major chest
wall trauma
► Present in 70 to 80 % of penetrating
and major non penetrating trauma .
►Sign & symptoms :
► Signs of Shock , Frothy Bloody
sputum , collapsed neck veins ,cool,
clammy skin, chills and restlessness
►Source of bleeding :
► intercostal vessels, internal
mammary vessels , lung
parenchyma, bronchial arteries,
major pulmonary vessels ,heart and
great vessels

35. Management
► ABC’s : secure airway , assist the breathing with
high o2 .
►Rapid transport .
►A hemothorax is managed by removing the source
of bleeding and by draining the blood.
*Indications for urgent thoracotomy
►Chest drainage >1250 ml
►or >1000 ml with hypotension
► or >200 ml per hour for 3 hours

36. Chest tube indicated to drain the contents of the
pleural space , usually air or blood ,but may include
other contents .

39. Contra-
indication:
►Refractory
coagulopathy .
►lack of
cooperation by
the patient
►diaphragmatic
hernia
Relative
indication
►Rib fracture &
positive.
►pressure
ventilation.
►Profound
hypoxia/
hypotension and
penetrating injury.
► Profound
hypoxia /
hypotension and
unilateral
hemothorax.
Absolute
indications
►Pneumothorax
(tension , open or
closed )
►Hemothorax .
►Bilateral
traumatic arrest

40. Pulmonary contusion
► Bleeding into the lung itself is a pulmonary
contusion
► The excess fluid interferes with gas exchange ,
potentially leading to inadequate oxygen levels
(hypoxia) .
► occurs in 25–35% of all blunt chest trauma .
► About 70% of cases result from motor vehicle
collision .

41. Sign & symptoms:
►Soft crackles may be heard over injury site
►Chest pain, point tenderness, and localized
swelling over area of impact
Diagnosis :
►X-ray
►CT is a more sensitive test for pulmonary
contusion

42. ►A CT scan showing a
pulmonary contusion
(red arrow)
accompanied by a rib
fracture
(blue arrow)

43. Management :
►Supply high-flow supplemental oxygen .
►analgesics.
►Support ventilation as needed with
Mechanical ventilation (in the patient with worsening
pulmonary insufficiency).

44. Cadiac inuries
1 )Pericardial tamponade :
► Emergency condition in which fluid accumulates in
the pericardium (the sac in which the heart is
enclosed).
►Usually result from a penetrating chest trauma with
laceration to the heart itself .
►Blood filling the pericardial sac compresses the heart,
witch prevents the heart's ventricles from filling
properly. This in turn leads to a low stroke volume
►The end result is ineffective pumping of blood , shock ,
and often death.

45. Sign & symptoms:
The classical cardiac tamponade presents three signs
known as Beck's triad. (Hypotension , jugular-venous
distension , and muffled heart sounds ) .
other signs , like pulses paradoxux and ECG changes
as well as general signs & symptoms of shock .
Management :
ABC’s With High Flow oxygen .
Treat S/S of shock .
Notify Hospital and ALS Unit as soon as possible
Pericardiocentesis :Using aseptic technique, Insert at
least 3” needle at the angle of the Xiphoid Cartilage at
the 7th rib.

46. 2 ) Myocardial contusion :
►Common site: Rt ventricle
►Considered in trauma patients with blunt chest
injury and unexplained hypotension or ECG
abnormalities
Diagnosis :
► clinical eg: fractured sternum
►ECG: (arrhythmia, ST elevation).
►CPK-MB
►Echocardiography

47. Management :
►ABC + high flow o2, ventilation support as needed
►Cardiac monitor
►Antiarrhythmic drugs.
►Inotropic support.
►request ALS backup .

48. Blood vessel injuries
Aortic injury (Traumatic aortic
rupture) :
 The aorta is torn or ruptured as the
result of trauma.
 It s frequently fatal due to the
profuse bleeding
 Occurs when the body suddenly
decelerates but the organs
continue to move.
 Common sites: The most
common site of injury is the aortic
isthmus ,
 Symptoms-signs: sever chest or
back pain, weak or absent femoral
pulses, unequal arm BPs .

49. Diagnosis
►After a clinical evaluation, most patients are best
evaluated wit CXR followed by Chest CT or
Angiography.
► however CXR demonistrat a classical finding

50. ► widened
mediastinum.
► blurred aortic
knob.
► Aortopulmonary
window
opacification.
► First or second
rib #.
► NG tube
deviation.
► Depressed Lt
mainstem
bronchus.
► Pleural apical
capping.
► Widened
paratracheal
stripe.

51. Management
►ABC’s
►Surgical repair, usually with cardiopulmonary
bypass technique

52. Diaphragmatic Rupture
►Common site:
Lt
hemidiaphragm
►Symptoms-
signs: dyspnea,
orthopnea,
chest pain,
bowel sounds in
the chest

53. Diagnosis
CXR: NG tube or bowel in the chest, gastric
distention with ipsilateral lung collapse.
Management
► surgical repair

54. THANK YOU