definition and approach to blunt chest trauma

2. CHEST TRAUMA
DR. QASIM ALABBOUD
SURGICAL SPECIALIST

3. CHEST TRAUMA
• Blunt versus penetrating traumaBlunt versus penetrating trauma
• Injury dependent on mechanismInjury dependent on mechanism
• Motor vehicle accidentMotor vehicle accident
• Fall from heightFall from height
• Physical assaultPhysical assault
• Explosive blastExplosive blast
• Gunshot woundGunshot wound
• Stab woundStab wound

4. CHEST TRAUMA
Blunt force injuries
from assault or fall from height
Bony fractures
Lung injuries
Cardiac contusion

5. CHEST TRAUMA
Acceleration : Deceleration Injuries

6. CHEST TRAUMA
Penetrating injuries:
Gunshot wounds
Stabbing wounds

7. CHEST TRAUMA
• Improved field diagnosis and treatment
of life threatening conditions
• Rapid evacuation to higher level of care
• High risk of death despite acute
intervention
• Need for prompt diagnosis and
treatment

8. CHEST TRAUMA
Chest wall and ribs
Lungs and pleura
Great and thoracic
vessels
Heart and
mediastinal
structures
Diaphragm

9. CHEST TRAUMA
Common Injuries
• Rib fractures
• Sternal fractures
• Open or Closed Pneumothorax
- unilateral / bilateral
• Hemothorax
• Hemopneumothorax

10. CHEST TRAUMA
Clinical consequences associated with:
• Mechanism of injury
• Location of injury
• Associated injuries
• Co-morbidities

11. CHEST TRAUMA
INITIAL MANAGEMENT
• Airway, Breathing, Circulation
• PRIMARY SURVEY
• Identify & treat immediately life threatening
conditions

12. CHEST TRAUMA
Early intervention directed toward
diagnosing and treating:
• Tension pneumothorax
• Massive hemothorax
• Open pneumothorax
• Cardiac tamponade
• Flail chest

13. CHEST TRAUMA
RADIOLOGIC TESTS
Chest X-ray, usually portable
Abdominal KUB and FAST Ultrasound Exam
CT scan, and CT Angiogram if needed

14. CHEST TRAUMA
Rib Fractures
Physical Diagnosis:
Deformity
Localized pain
Crepitus
Treatment:
Analgesia ,
Pulmonary toilet
Observe for pneumothorax

15. CHEST TRAUMA
FLAIL CHEST
Segment of chest wall that does not have
continuity with rest of thoracic cage
• Usually 2 fractures per rib in at least 2 ribs
• Segment does not contribute to lung expansion
• Disrupts normal pulmonary mechanics
• Accompanied by pulmonary contusion in 50% of
patients

16. CHEST TRAUMA
Flail Chest Diagnosis:
• Paradoxical chest wall movement
• Poor air movement
• Hypoxia
Therapy:
• Pain control
• Pulmonary & physical therapy
• Intubation and ventilator support if needed
• Fluid restriction if possible

17. CHEST TRAUMA
 Pneumothorax or HemothoraxPneumothorax or Hemothorax
• most treated with simple tubemost treated with simple tube
thoracostomythoracostomy

18. CHEST TRAUMA
Decompression of Tension Pneumothorax
• large bore needle
 2nd intercostal space
 midclavicular line
• Chest tube as definitive treatment

19. PULMONARY CONTUSION
• Common with blunt trauma
• May be associated with laceration of
lung parenchyma
• Leakage of blood and fluid into
interstitial spaces of lung
• Significant inflammatory reaction to
blood components in the lung

20. PULMONARY CONTUSION
ParenchymalParenchymal
infiltrate seen oninfiltrate seen on
CXR adjacent toCXR adjacent to
injured chest wallinjured chest wall

21. PULMONARY CONTUSION
Indications for intubation
• Respiratory distress
• Hypoxia
• Other injuries which compromise
respiratory effort, such as abdominal
or neurologic

22. MASSIVE HEMOTHORAXMASSIVE HEMOTHORAX
• From blunt or penetrating injuries
• 200cc – 1L in chest cavity seen on CXR
• Treat with chest tube,
• if immediate drainage is 1500 cc or if 250
cc/hr for 4 hours, then immediate
thoracotomy
• Bleeding may be from ribs, lung, blood
vessels

23. AORTIC RUPTURE
• Abrupt deceleration or compression injury
• Sudden motion of heart or great vessels in
chest
• Often rapidly fatal
• 10% survive to hospital
• 20% survive > 1 hour
• 90% who reach hospital will die
• Early diagnosis and treatment

24. AORTIC RUPTURE
• mechanism of injury
• widened
mediastinum on
CXR

25. DIAPHRAGM RUPTURE
• Associated with
• blunt trauma or blast injury
• Can be due to stab wounds

26. DIAPHRAGM RUPTURE
• Surgical repair to replace herniated contents
back into abdomen
• Close muscular diaphragm to restore
pulmonary function
• Chest tube to treat pneumothorax

27. CHEST TUBE INSERTION
Insertion Site
• mid or anterior axillary line behind pectoralis
major
• above 5th rib avoid diaphragm

28. CHEST TUBE INSERTION
• Connect tube to
underwater seal and
suture in place
• Examine chest to
check effect
• CXR to check
placement and
position

29. Thank youThank you