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CHEST TRAUMA
Dr. Muhammad Aslam
INTRODUCTION
• Trauma is third leading cause of death but it is
first leading cause of death below the age of
forty.
• 25% of deaths due to trauma are because of
chest trauma.
CLASSIFICATION OF CHEST TRAUMA
• Blunt trauma
• Penetrating trauma
• Compression Injuries.
Injuries below nipple are also considered as
abdominal injuries as there may be injury to
diaphragm and abdominal visceras may herniate
into chest cavity.
CHEST WALL INJURIES
• Hematoma
• Rib Fracture.
• Sternal Fracture.
• Flail Chest.
PULMONARY INJURIES
• Pulmonary Contusion.
• Simple Pneumothorax.
• Tension Pneumothorax.
• Open Pneumothorax.
• Hemothorax.
• Hemo-pneumothorax.
OTHER INJURIES
• Cardiac Temponade.
• Tracheo-Broncheal Injuries.
• Esophageal Injuries.
EXAMINATION OF PATIENTS WITH
CHEST TRAUMA
• Follow protocoal of trauma as; A,B,C,D,E i.e.
primary & secondary survey.
• Inspection, palpation and auscultation.
RIB FRACTURES
• Rib fractures may cause pulmonary contusion
resulting into pneumo or hemothorax.
• Fractures on right lower chest may cause liver
injury.
• Fractures on left lower chest may cause
splenic injury
• Rib fractures are managed conservatively. Pain
is relieved by analgesics.
FLAIL CHEST
–Two or more than two adjacent ribs fracture
in two or more places
–Serious chest wall injury with underlying
pulmonary injury
–Paradoxical flail segment movement
– Chest tube insersion may be needed if
there is hemo or pneumothorax.
–Positive pressure ventilation may be
needed.
Simple Pneumothorax
• Opening in lung tissue that leaks air into chest
cavity
• Blunt trauma is main cause
• May be spontaneous
• Usually self correcting
Signs & symptoms of Simple
Pneumothorax
• Chest Pain
• Dyspnea
• Tachypnea
• Decreased Breath Sounds on Affected Side
TREATMENT is chest tube insertion & good
analgesia.
TENSION PNEUMOTHORAX
– Buildup of air under pressure in the thorax.
– Excessive pressure reduces effectiveness of
respiration
– Air is unable to escape from inside the pleural
space
– Results in collapse of lung on affected side that
results in pressure on mediastium,the other lung,
and great vessels
SIGNS & SYMPTOMS
• Severe Dyspnea
• Absent Breath sounds on affected side
• Tachypnea
• Tracheal Deviation
• Dilated neck veins
TREATMENT
Needle Decompression
• Locate 2nd Intercostal space in midclavicular line
• Clean area using aseptic technique
• Insert needle in 2nd intercostal space and continue to
suck the air then chest tube is inserted.
OPEN PNEUMOTHORAX
• Opening in chest cavity that allows air to enter
pleural cavity
• Causes the lung to collapse due to increased
pressure in pleural cavity
• Can be life threatening and can deteriorate
rapidly
• Wounds are sucking wounds.
SIGNS & SYMPTOMS
• Dyspnea
• Sudden sharp pain
• Subcutaneous Emphysema
• Decreased lung sounds on affected side
• Sucking chest wound
TREATMENT
• Apply occlusive dressing to wound
• Closure of wound
• Insertion of chest tube
HEMOTHORAX
• Occurs when pleural space fills with blood
• Usually occurs due to lacerated blood vessel in
thorax
• As blood increases, it puts pressure on heart
and other vessels in chest cavity
• Each Lung can hold 1.5 liters of blood
SIGNS & SYMPTOMS
• Tachypnea
• Signs of Shock
• Diminished Breath Sounds on Affected Side
• Tachycardia
• Chest tube insertion.
INDICATION FOR THORACOTOMY
• After insertion of chest tube, if 1000cc of
blood comes out stat, then 200cc of blood/hr
for three hours
• If there is esophageal injury
• Cardiac temponade
SAFETY TRIANGLE
• Safety triangle is bounded anteriorly by lateral
border of pectoralis major, inferiorly at the
level of nipple & posteriorly by anterior border
of latissimus dorsi.
• Chest tube is inserted in 4th intercostal space
in mid axillary line.

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chest trauma.pptx

  • 2. INTRODUCTION • Trauma is third leading cause of death but it is first leading cause of death below the age of forty. • 25% of deaths due to trauma are because of chest trauma.
  • 3. CLASSIFICATION OF CHEST TRAUMA • Blunt trauma • Penetrating trauma • Compression Injuries. Injuries below nipple are also considered as abdominal injuries as there may be injury to diaphragm and abdominal visceras may herniate into chest cavity.
  • 4. CHEST WALL INJURIES • Hematoma • Rib Fracture. • Sternal Fracture. • Flail Chest.
  • 5. PULMONARY INJURIES • Pulmonary Contusion. • Simple Pneumothorax. • Tension Pneumothorax. • Open Pneumothorax. • Hemothorax. • Hemo-pneumothorax.
  • 6. OTHER INJURIES • Cardiac Temponade. • Tracheo-Broncheal Injuries. • Esophageal Injuries.
  • 7. EXAMINATION OF PATIENTS WITH CHEST TRAUMA • Follow protocoal of trauma as; A,B,C,D,E i.e. primary & secondary survey. • Inspection, palpation and auscultation.
  • 8. RIB FRACTURES • Rib fractures may cause pulmonary contusion resulting into pneumo or hemothorax. • Fractures on right lower chest may cause liver injury. • Fractures on left lower chest may cause splenic injury • Rib fractures are managed conservatively. Pain is relieved by analgesics.
  • 9. FLAIL CHEST –Two or more than two adjacent ribs fracture in two or more places –Serious chest wall injury with underlying pulmonary injury –Paradoxical flail segment movement – Chest tube insersion may be needed if there is hemo or pneumothorax. –Positive pressure ventilation may be needed.
  • 10. Simple Pneumothorax • Opening in lung tissue that leaks air into chest cavity • Blunt trauma is main cause • May be spontaneous • Usually self correcting
  • 11. Signs & symptoms of Simple Pneumothorax • Chest Pain • Dyspnea • Tachypnea • Decreased Breath Sounds on Affected Side TREATMENT is chest tube insertion & good analgesia.
  • 12. TENSION PNEUMOTHORAX – Buildup of air under pressure in the thorax. – Excessive pressure reduces effectiveness of respiration – Air is unable to escape from inside the pleural space – Results in collapse of lung on affected side that results in pressure on mediastium,the other lung, and great vessels
  • 13. SIGNS & SYMPTOMS • Severe Dyspnea • Absent Breath sounds on affected side • Tachypnea • Tracheal Deviation • Dilated neck veins
  • 14. TREATMENT Needle Decompression • Locate 2nd Intercostal space in midclavicular line • Clean area using aseptic technique • Insert needle in 2nd intercostal space and continue to suck the air then chest tube is inserted.
  • 15. OPEN PNEUMOTHORAX • Opening in chest cavity that allows air to enter pleural cavity • Causes the lung to collapse due to increased pressure in pleural cavity • Can be life threatening and can deteriorate rapidly • Wounds are sucking wounds.
  • 16. SIGNS & SYMPTOMS • Dyspnea • Sudden sharp pain • Subcutaneous Emphysema • Decreased lung sounds on affected side • Sucking chest wound
  • 17. TREATMENT • Apply occlusive dressing to wound • Closure of wound • Insertion of chest tube
  • 18. HEMOTHORAX • Occurs when pleural space fills with blood • Usually occurs due to lacerated blood vessel in thorax • As blood increases, it puts pressure on heart and other vessels in chest cavity • Each Lung can hold 1.5 liters of blood
  • 19. SIGNS & SYMPTOMS • Tachypnea • Signs of Shock • Diminished Breath Sounds on Affected Side • Tachycardia • Chest tube insertion.
  • 20. INDICATION FOR THORACOTOMY • After insertion of chest tube, if 1000cc of blood comes out stat, then 200cc of blood/hr for three hours • If there is esophageal injury • Cardiac temponade
  • 21. SAFETY TRIANGLE • Safety triangle is bounded anteriorly by lateral border of pectoralis major, inferiorly at the level of nipple & posteriorly by anterior border of latissimus dorsi. • Chest tube is inserted in 4th intercostal space in mid axillary line.