1) Chest trauma is a common cause of injury and death, especially from road traffic accidents, gunshot wounds, and falls. 2) The initial evaluation and resuscitation of chest trauma patients follows the ATLS protocol, assessing the ABCDEs: Airway, Breathing, Circulation, Disability, and Exposure. 3) Common chest injuries include pneumothorax, hemothorax, and flail chest. Tension pneumothorax requires immediate needle decompression. Management involves chest tube placement, oxygen, monitoring, and treatment of underlying conditions.

1. Assessment and management of chest
trauma as a cause of respiratory distress
By. Teshome B.(MD,Assistant Professor
of Surgery)

2. INTRODUCTION
• Trauma, or injury, is defined as cellular disruption caused by
environmental energy that is beyond the body’s resilience,
which is compounded by cell death due to
ischemia/reperfusion.
• Trauma is the most common cause of death for all individuals
between the ages of 1 and 44 years, and is the third most
common cause of death regardless of age.
• 25% of all trauma deaths are the result of chest injuries alone.
• It is also the leading cause of years of productive life lost.

3. Causes
• Road traffic accidents
• Bullet injuries
• Blast injuries
• Industrial accidents
• Stab injuries.

4. Types of Chest Trauma
• Blunt Trauma(>80% of all chest injuries.)
=> Blunt force to chest.
– Motor vehicle accidents(2/3)
– Fall & crush injuries
– Blast injuries
• Penetrating Trauma- Projectile that enters chest
causing small or large hole.
– Gunshot wounds
– Stab wounds
– Shrapnel wounds
• Compression Injury- Chest is caught between two
objects and chest is compressed.
The most
common
4

5. INITIAL EVALUATION AND RESUSCITATION OF
THE INJURED PATIENT
Primary Survey
• ATLS (Advanced Trauma Life Support)
• Provides a structured approach to the trauma patient
with standard algorithms of care
• It emphasizes the “golden hour” concept that timely,
prioritized interventions are necessary to prevent death
and disability

6. The initial management of seriously injured patients
consists of phases that include
• The primary survey/concurrent resuscitation,
• The secondary survey/diagnostic evaluation,
• Definitive care
• The tertiary survey.

7. • The first step in patient management is performing the
primary survey. Goal?
• The ATLS course refers to the primary survey as
assessment of the “ABCs” (Airway with cervical spine
protection, Breathing, and Circulation).

8. Components of Primary Survey
• Airway(A)=Asses airway and Cervical spine
• Breathing(B)=Asses breathing by checking breathing pattern,
RR,SPO2, air entry
• Circulation(C)=Asses for hemodynamic status and bleeding. Hence,
check BP,PR and potential site of bleeding
• Disablity(D)=Asses neurologic status(GCS,Pupil,power,sensory)
• Exposure(E)=Bridge to secondary survey

10. Clinical Features of Thoracic Injuries
• H/O trauma, painful breathing, cough, haemoptysis, pain
in the chest wall, external wound on the chest wall
• Features of shock, may be seen, i.e. tachycardia,
hypotension, cold periphery.
• May present with respiratory distress tachypnea,
cyanosis, respiratory difficulties

11. EXAMINATION IN CHEST INJURIES
• Detailed history of trauma should be asked.
• History of breathlessness, chest pain, haemoptysis/cough
with blood (lung trauma), air way block should be asked.
• Pain in the ribs may be due to rib fracture.
• Excruciating pain on deep breathing suggests rib fracture.

12. Examination
• General Examination
• Pulse, blood pressure, cyanosis, tachypnea, features of
shock should be checked.
• Abdomen, limbs, head and neurological systems also be
examined.

13. Inspection
• Chest, abdomen and neck should be exposed for proper
inspection.
• Ecchymosis, bruises in the skin over chest wall should be
inspected.

14. • Wound may often look small superficially but may be
deep penetrating into the thoracic cavity.
• Air may be bubbling through the wound with noise.
• Blood, clot may be present in such wounds.
• Such patient often may need emergency resuscitation to
maintain adequate ventilation.

15. • Type of breathing – abdominal or thoracic and its
character should be checked.
• Hyperpnea, dyspnea, altered breathing should be
observed.
• Collapse of chest wall during inspiration and distension of
part of chest wall during expiration suggests flail chest
with paradoxical breathing, mediastinal flutter and
pendular movement of the air.

16. • If patient develop sudden distress in breathing and
sudden respiratory arrest, it suggest likely the cause is
tension pneumothorax .
• Localized swelling due to hematoma may be evident.
• Diffuse puffy look suggests surgical emphysema. It may
be in the chest wall, abdomen, neck both sides.

17. Palpation
• Rib tenderness, bone
irregularity, crepitus should
be checked for fracture rib.
• If there is diffuse swelling
over the chest and if crepitus
felt under palpation, It
suggests surgical
emphysema

18. Percussion
• Resonant on percussion in case of pneumothorax and
dull in hemothorax.
Auscultation
• Breath sounds is reduced in pneumothorax or
hemothorax

19. Investigations
• Baseline =HCT,BG&RH
• Chest X-ray
– To see fracture ribs, pneumothorax, haemothorax,
haemopneumothorax.
• Ultrasound of the chest wall to confirm fluid/blood/air

20. General mgt of chest trauma patient
• Secure IV line (give fluid if needed)
• Analgesics(strong antipain)
• Antibiotics(if patient have wound)
• Chest physiotherapy
• Chest tube care (if in place)
• Oxygen and frequent monitoring
• NB: All the above mgt shouldn`t delay patient from
treatment of underlying condition

21. Management of specific injuries
Pneumothorax
• Air in pleural space
• Many are caused by trauma but from primary problem in lung
• Causes collapse of a lung on the affected side
• May be caused by fractures of ribs, stab or bullet

22. Types
Tension pneumothorax
22

23. Clinical features
• Tachypnoea
• Dyspnea
• Distended neck veins
• Tachycardia
• Use of acce. Muscles
• Hypotension
• Tracheal deviation
• Hyperresonance
• Absent breath sound
• Failure of chest
expansion
23

24. Diagnosis
• Clinical
Management
• Don’t wait for CXR!!!!!!
• Consult Physician
• Immediate decompression-Insert needle in 2nd ICS to convert
tension pneumothorax to simple pneumothorax
– Definitive mgt for both is chest tube drainge
24

25. 25

26. Open pneumothorax(sucking chest wound)
• Due to a large defect (>3cm)
• Air enters and leaves pleural space but
not as in tension pneumothorax
• Can be changed to tension
• Signs & sym. Proportional to size of defect
26

27. Open Pneumothorax
27

28. 28

29. Clinical features
 Dyspnea
 Sudden sharp pain
 Subcutaneous emphysema
 Decreased breath sound on affected side
 Red Bubbles on Exhalation from wound (Sucking chest
wound)
29

30. Mgt
• 3 sided dressing
• Link or refer for chest tube
30

31. Haemothorax
• More commonly secondary to penetrating than blunt
• Small or massive
• Can be with pneum-
Thorax
31

32. Clinical features
 Anxiety/Restlessness
 Tachypnea
 Tachycardia
 Signs of Shock
 Flat neck veins
 Resp. distress
 Reduced chest expansion
 Diminished Breath Sounds on Affected Side
 Dullness to percussion
32

33. Management
• Put on fluid to correct hypovolemia
• Consult or link or refer for chest tube.
33

34. Cardiac Tamponade
• Mostly follow penetrating injury
• Acutely,<100ml of pericardial blood can cause tamponade
• Impairs atrial filling and also cause myocardial ischemia
• Beck`s triad?
• Ix-Pericardial ultrasound
• Mgt-removing 15-20ml blood can alleviate smx
hence early consultation or referral

35. Thank you