Chest trauma can be life-threatening and accounts for 25% of all trauma deaths. It includes injuries from blunt forces like rib fractures or penetrating injuries from stab wounds. Without treatment, injuries can lead to hypoxia and hypotension from issues like pneumothorax, hemothorax, or flail chest. Proper management requires following ABC (airway, breathing, circulation) to ensure oxygen delivery and addressing specific injuries like tension pneumothorax through needle decompression or chest tube insertion.

1. Chest Trauma
Gráinne Murphy
Final Med
April 2002

2. Introduction
 Chest trauma is often sudden and
dramatic
 Accounts for 25% of all trauma deaths
 2/3 of deaths occur after reaching
hospital
 Serious pathological consequnces:
-hypoxia, hypovolaemia, myocardial
failure

3. Mechanism of Injury
Penetrating injuries
 E.g. stab wounds etc.
 Primarily peripheral lung
 Haemothorax
 Pneumothorax
 Cardiac, great vessel or oesophageal
injury

4.  Either:
- direct blow (e.g. rib fracture)
- deceleration injury or
- compression injury
 Rib fracture is the most common sign of
blunt thoracic trauma
 Fracture of scapula, sternum, or first rib
suggests massive force of injury
Blunt injuries

5. Chest wall injuries
 Rib fractures
 Flail chest
 Open pneumothorax

6. Rib fractures
 Most common thoracic injury
 Localised pain, tenderness, crepitus
 CXR to exclude other injuries
 Analgesia..avoid taping
 Underestimation of effect
 Upper ribs, clavicle or scapula fracture:
suspect vascular injury

7. Flail chest
 Multiple rib fractures produce a mobile
fragment which moves paradoxically
with respiration
 Significant force required
 Usually diagnosed clinically
 Rx: ABC
Analgesia

8. Flail chest

9. Flail Chest - detail

10. Open pneumothorax
 Defect in chest wall provides a direct
communication between the pleural
space and the environment
 Lung collapse and paroxysmal shifting
of mediastinum with each respiratory
effort ± tension pneumothorax
 “Sucking chest wound”
 Rx: ABCs…closure of wound…chest
drain

11. Lung injury
 Pulmonary contusion
 Pneumothorax
 Haemothorax
 Parenchymal injury
 Trachea and bronchial injuries
 Pneumomediastinum

12. Pneumothorax
 Air in the pleural cavity
 Blunt or penetrating injury that disrupts
the parietal or visceral pleura
 Unilateral signs: movement and breath
sounds, resonant to percussion
 Confirmed by CXR
 Rx: chest drain

13. Pneumothorax

14. Tension pneumothorax
 Air enters pleural space and cannot
escape
 P/C: chest pain, dyspnoea
 Dx: - respiratory distress
- tracheal deviation (away)
- absence of breath sounds
- distended neck veins
- hypotension

15.  Surgical emergency
 Rx: emergency decompression before
CXR
 Either large bore cannula in 2nd ICS,
MCL or insert chest tube
 CXR to confirm site of insertion

16. Haemothorax
 Blunt or penetrating trauma
 Requires rapid decompression and fluid
resuscitation
 May require surgical intervention
 Clinically: hypovolaemia
absence of breath sounds
dullness to percussion
 CXR may be confused with collapse

17. Heart, Aorta & Diaphragm
 Blunt cardiac injury
- contusion
- ventricular, septal or valvular
rupture
 Cardiac tamponade
 Ruptured thoracic aorta
 Diaphragmatic rupture

18. Cardiac Tamponade
 Blood in the pericardial sac
 Most frequently penetrating injuries
 Shock, JVP, PEA, pulsus paradoxus
 Classically, Beck’s triad: -
distended neck veins -
muffled heart sounds -
hypotension
 Rx: Volume resuscitation
Pericardiocentesis

19. Cardiac tamponade

20. Aortic rupture
 Usually blunt trauma involving
deceleration forces; especially RTAs
 ~90% die within minutes
 Most common site near ligamentum
arteriosum
 Dx: clinical suspicion, CXR, aortography,
contrast CT or TOE
 Rx: surgical…poor prognosis

21. Aortic rupture

22. Iatrogenic trauma
 NG tubes: -coiling
-endobronchial placement
-pneumothorax
 Chest tubes: - subcutaneous
- intraparenchymal
- intrafissural
 Central lines: - neck
- coronary sinus
- pneumothorax

23. Line in jugular vein

24. Misplaced nasogastric tube

25. Chest trauma: summary
 Common
 Serious
 Primary goal is to provide oxygen to
vital organs
 Remember
Airway
Breathing
Circulation
 Be alert to change in clinical condition