Emergency Thoracotomy
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This document discusses emergency thoracotomy procedures for traumatic thoracic injuries. It notes that 25-50% of all traumatic injuries involve the thorax, and that emergency thoracotomy may be necessary for patients experiencing deterioration in the pre-hospital or emergency department setting. The document outlines indications and contraindications for emergency thoracotomy based on whether the injury is penetrating or blunt, lists necessary equipment, describes the procedure steps, and notes factors involved in determining when to terminate the procedure.
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Emergency Thoracotomy
Emergency thoracotomy is a procedure performed in the emergency department or operating room to treat penetrating or blunt chest trauma with signs of life. It involves making an incision in the chest wall to access the heart, lungs, and great vessels to control bleeding, release pericardial tamponade, or perform open cardiac massage. Factors associated with increased survival include signs of life on arrival, penetrating rather than blunt trauma, shorter duration of CPR, and certain cardiac rhythms. Proper patient preparation, equipment, and a trained team are required to perform the procedure. Complications can include bleeding, infection, and injury to surrounding structures.
Emergency Thoracotomy
This document discusses emergency thoracotomy for traumatic injuries. It outlines indications for the procedure including hemodynamic instability from penetrating chest injuries or cardiac tamponade. Steps of the procedure are described including a clamshell incision and interventions like controlling hemorrhage, cardiac massage, and aortic clamping. Contraindications include prolonged downtime or signs of unsurvivable injuries. Studies show improved survival in penetrating injuries with signs of life when thoracotomy is performed in the ED. Proper training and equipment are needed to perform this critical lifesaving procedure.
Chest trauma
This document provides an overview of chest trauma, including the leading causes, types of injuries, clinical presentation, investigations, and management strategies. It discusses specific injuries such as pneumothorax, hemothorax, flail chest, cardiac tamponade, and aortic rupture. The summary emphasizes that chest trauma is a leading cause of trauma deaths, often involves multiple injuries, and requires rapid diagnosis and treatment of life-threatening conditions like tension pneumothorax to prevent death.
Diaphragmatic injury
This document discusses diaphragmatic injury, including its etiology, associated injuries, signs and symptoms, diagnostic approaches, and management. The majority of diaphragmatic injuries are caused by penetrating trauma, most commonly stab wounds or gunshots. Left-sided injuries are more often associated with blunt trauma from high pressure to the chest or abdomen. Common associated injuries include damage to the spleen, ribs, liver, lungs, head, pelvis, and bowels. Diagnosis can be made through chest x-rays, ultrasound, CT scans, or laparoscopy. Surgical repair is usually required to suture tear sizes over 2 cm. Complications include herniation of abdominal organs into the chest and pulmonary issues if left
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This document summarizes various types of thoracic trauma. It covers epidemiology, injuries to the chest wall including rib fractures and flail chest. It also discusses pulmonary injuries such as pulmonary contusion, pneumothorax, hemothorax, and tracheobronchial injuries. Cardiovascular injuries addressed include myocardial contusion, myocardial rupture, penetrating cardiac injury, and acute pericardial tamponade. Management strategies are provided for each type of injury.
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This document discusses esophageal injury, including its anatomy, causes, symptoms, diagnosis and management. The esophagus extends from the pharynx to the stomach. Injuries are often caused by medical procedures but can also result from trauma or spontaneous rupture. Symptoms vary depending on the location but may include chest pain, vomiting and subcutaneous emphysema. Diagnosis involves imaging and endoscopy. Treatment depends on factors like timing and location but typically involves antibiotics, nil by mouth, drainage and sometimes stents or surgery to repair the injury. Outcomes are best when treatment begins quickly but morbidity and mortality remain high if sepsis develops.
Thoracic Trauma
This document summarizes various types of thoracic trauma, including mechanisms of injury, anatomical injuries, pathophysiology, assessment findings, and management strategies. Some key injuries discussed include rib fractures, flail chest, pneumothorax, hemothorax, pulmonary contusion, myocardial contusion, pericardial tamponade, aortic dissection/rupture, and traumatic asphyxia.
CHEST INJURY- BLUNT- Trauma Surgery
Chest trauma, especially blunt chest trauma, can cause many serious injuries from rib fractures to life-threatening conditions like tension pneumothorax. It is the second leading cause of trauma deaths. Immediate life-threatening injuries include tension pneumothorax, massive hemothorax, flail chest, and cardiac tamponade which must be quickly diagnosed and treated to prevent death. Other potential injuries include pulmonary contusions, pneumothorax, and aortic disruption which require close monitoring and treatment.
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Emergency Thoracotomy
Emergency thoracotomy is a procedure performed in the emergency department or operating room to treat penetrating or blunt chest trauma with signs of life. It involves making an incision in the chest wall to access the heart, lungs, and great vessels to control bleeding, release pericardial tamponade, or perform open cardiac massage. Factors associated with increased survival include signs of life on arrival, penetrating rather than blunt trauma, shorter duration of CPR, and certain cardiac rhythms. Proper patient preparation, equipment, and a trained team are required to perform the procedure. Complications can include bleeding, infection, and injury to surrounding structures.
Emergency Thoracotomy
This document discusses emergency thoracotomy for traumatic injuries. It outlines indications for the procedure including hemodynamic instability from penetrating chest injuries or cardiac tamponade. Steps of the procedure are described including a clamshell incision and interventions like controlling hemorrhage, cardiac massage, and aortic clamping. Contraindications include prolonged downtime or signs of unsurvivable injuries. Studies show improved survival in penetrating injuries with signs of life when thoracotomy is performed in the ED. Proper training and equipment are needed to perform this critical lifesaving procedure.
Chest trauma
This document provides an overview of chest trauma, including the leading causes, types of injuries, clinical presentation, investigations, and management strategies. It discusses specific injuries such as pneumothorax, hemothorax, flail chest, cardiac tamponade, and aortic rupture. The summary emphasizes that chest trauma is a leading cause of trauma deaths, often involves multiple injuries, and requires rapid diagnosis and treatment of life-threatening conditions like tension pneumothorax to prevent death.
Diaphragmatic injury
This document discusses diaphragmatic injury, including its etiology, associated injuries, signs and symptoms, diagnostic approaches, and management. The majority of diaphragmatic injuries are caused by penetrating trauma, most commonly stab wounds or gunshots. Left-sided injuries are more often associated with blunt trauma from high pressure to the chest or abdomen. Common associated injuries include damage to the spleen, ribs, liver, lungs, head, pelvis, and bowels. Diagnosis can be made through chest x-rays, ultrasound, CT scans, or laparoscopy. Surgical repair is usually required to suture tear sizes over 2 cm. Complications include herniation of abdominal organs into the chest and pulmonary issues if left
Thoracic Trauma
This document summarizes various types of thoracic trauma. It covers epidemiology, injuries to the chest wall including rib fractures and flail chest. It also discusses pulmonary injuries such as pulmonary contusion, pneumothorax, hemothorax, and tracheobronchial injuries. Cardiovascular injuries addressed include myocardial contusion, myocardial rupture, penetrating cardiac injury, and acute pericardial tamponade. Management strategies are provided for each type of injury.
Esophageal injury
This document discusses esophageal injury, including its anatomy, causes, symptoms, diagnosis and management. The esophagus extends from the pharynx to the stomach. Injuries are often caused by medical procedures but can also result from trauma or spontaneous rupture. Symptoms vary depending on the location but may include chest pain, vomiting and subcutaneous emphysema. Diagnosis involves imaging and endoscopy. Treatment depends on factors like timing and location but typically involves antibiotics, nil by mouth, drainage and sometimes stents or surgery to repair the injury. Outcomes are best when treatment begins quickly but morbidity and mortality remain high if sepsis develops.
Thoracic Trauma
This document summarizes various types of thoracic trauma, including mechanisms of injury, anatomical injuries, pathophysiology, assessment findings, and management strategies. Some key injuries discussed include rib fractures, flail chest, pneumothorax, hemothorax, pulmonary contusion, myocardial contusion, pericardial tamponade, aortic dissection/rupture, and traumatic asphyxia.
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Chest trauma, especially blunt chest trauma, can cause many serious injuries from rib fractures to life-threatening conditions like tension pneumothorax. It is the second leading cause of trauma deaths. Immediate life-threatening injuries include tension pneumothorax, massive hemothorax, flail chest, and cardiac tamponade which must be quickly diagnosed and treated to prevent death. Other potential injuries include pulmonary contusions, pneumothorax, and aortic disruption which require close monitoring and treatment.
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Chest injuries account for 25% of severe injuries and are usually caused by road traffic accidents. The primary survey focuses on the airway, breathing, circulation, disability and exposure to identify and treat immediate life threats like tension pneumothorax. Secondary survey involves a full history, examination and investigations like CXR and CT scan to evaluate injuries. Most chest injuries are managed conservatively but conditions like massive hemothorax or cardiac tamponade may require chest tube insertion or thoracotomy.
Thoracic trauma
Thoracic trauma is common, accounting for 50% of multiple trauma cases and 25% of trauma deaths. Potentially fatal thoracic injuries like tension pneumothorax, massive hemothorax, and cardiac tamponade require rapid recognition and intervention to save lives. The primary survey focuses on the "Deadly Dozen" immediate threats like airway obstruction, open pneumothorax, and flail chest, while the secondary survey evaluates less immediately life-threatening injuries like pulmonary contusion and myocardial contusion. Chest injuries frequently necessitate prompt treatment and often require urgent transport or "load-and-go" to definitive care.
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1) Penetrating chest injuries can damage the chest wall, lungs, heart, blood vessels, diaphragm or mediastinum. Signs and symptoms depend on the specific organ injured but may include pain, difficulty breathing, shock or abdominal symptoms.
2) For penetrating injuries to the heart (cardiac tamponade or wound), management depends on the patient's hemodynamic stability. Unstable patients require immediate thoracotomy while stable patients can be evaluated first with ultrasound or surgery.
3) Surgical techniques for penetrating cardiac injury include median sternotomy or left lateral thoracotomy. The pericardium is opened to access the heart. Bleeding from ventricles is controlled manually or with s
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Thoracic injuries account for a significant portion of trauma deaths. The leading cause of death from thoracic injury is hemorrhage. Immediately life-threatening thoracic injuries include tension pneumothorax, massive hemothorax, flail chest, and pericardial tamponade. These injuries require rapid diagnosis and treatment to prevent further deterioration. While many thoracic injuries can be managed non-operatively with oxygen, analgesia, and chest tube drainage, emergency thoracotomy may be necessary to control severe hemorrhage in the chest from injuries to organs like the heart or lungs. Proper investigation and management of thoracic trauma can prevent avoidable deaths.
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Thank you for the thorough management plan. Let me know if you need any other feedback!
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2. VATS involves making small incisions and inserting surgical instruments and a camera to allow the surgeon to see inside the chest. This avoids the need for large incisions.
3. VATS is used for procedures like lung biopsies, removal of parts of the lung, treatment of collapsed lungs, and draining fluid from the chest cavity. It offers benefits like less pain, shorter recovery time, and smaller scars compared to traditional open chest surgery.
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This document provides an overview of chest trauma, including:
- Common injuries like pneumothorax, hemothorax, flail chest and their signs and symptoms.
- Assessment involves clinical exam, chest x-ray and ultrasound to detect injuries. Chest tube insertion can be both therapeutic and diagnostic.
- "Deadly dozen" life-threatening injuries from chest trauma include tension pneumothorax, cardiac tamponade, aortic disruption and others that often require emergency procedures or surgery.
- Management involves airway control, ventilation, chest tube drainage, analgesia and monitoring for complications like respiratory failure. Operative treatment is indicated for severe injuries or those not responding to initial management.
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This document discusses various types of chest trauma, including pneumothorax, hemothorax, flail chest, diaphragmatic injury, aortic tear, esophageal rupture, pulmonary contusion, and cardiac tamponade. It provides details on the procedures used to treat chest trauma, such as intercostal drains and tracheostomy. Chest trauma can be caused by blunt or penetrating mechanisms and accounts for 20-25% of trauma deaths. Clinical features, investigations, and management are described for each type of chest injury.
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This document outlines the anatomy of the chest and describes various types of chest trauma, including blunt and penetrating injuries. It discusses the initial assessment and management of life-threatening injuries like tension pneumothorax, massive hemothorax, and cardiac tamponade. The document also covers procedures like needle decompression, tube thoracostomy, and emergency department thoracotomy that may be used to treat severe chest trauma. Overall, the document emphasizes the importance of promptly identifying and treating life-threatening injuries to the chest.
Chest trauma presentation
This document provides an overview of chest trauma. It begins by defining chest trauma as any injury to the chest, including the ribs, heart and lungs. Chest injuries are categorized as open or closed. Common causes are discussed, including blunt trauma from accidents or penetrating trauma from objects. Signs and symptoms, diagnostic tests, and specific injuries like pneumothorax are described. Treatment focuses on ABCs - airway, breathing and circulation while performing tests to evaluate cardiac and pulmonary function.
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Thoracotomy
A thoracotomy is a surgical procedure where an incision is made through the chest wall to access the organs within the chest cavity like the lungs and heart. It is performed by a thoracic surgeon or emergency physician in a hospital operating room or emergency department. Reasons for thoracotomy include diagnosing and treating conditions like lung cancer or injuries from the chest. Risks include bleeding, infection and pain during a long recovery period.
Chest Injuries
This document discusses various types of chest injuries including fractured ribs, flail segments, collapsed lungs, and sucking chest wounds. It provides information on recognizing each type of injury and the appropriate first aid management. Recognition signs include pain, bruising, deformity, difficulty breathing, and sounds of air entering open chest wounds. Management generally involves conducting an initial assessment, calling for emergency help if needed, stabilizing injuries, and providing supplemental oxygen.
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Tube thoracostomy is a procedure to drain fluid or air from the pleural space by inserting a chest tube. It is indicated for conditions such as pneumothorax, hemothorax, and postoperative drainage. The chest tube is inserted using sterile technique between the 4th and 5th ribs in the midaxillary line and connected to a water seal drainage system. Proper patient care involves monitoring drainage, respiratory status, and ensuring the drainage system remains patent. Complications include hemorrhage, lung laceration, and tube blockage or dislodgement.
Pulmonary contusion
Pulmonary contusion is injury to the lung parenchyma caused by blunt chest trauma, resulting in edema and bleeding into the alveolar spaces. It is commonly caused by motor vehicle accidents. Clinically, patients may experience respiratory distress, coughing blood, and decreased breath sounds. Chest x-rays often under-estimate the injury, while CT scans can detect contusions immediately and assess severity. Treatment involves supportive care, oxygen supplementation, ventilation if needed, and prevention of complications like ARDS and pneumonia. Most contusions resolve within a week but can occasionally lead to long-term lung issues.
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Chest injuries account for 25% of severe injuries and are usually caused by road traffic accidents. The primary survey focuses on the airway, breathing, circulation, disability and exposure to identify and treat immediate life threats like tension pneumothorax. Secondary survey involves a full history, examination and investigations like CXR and CT scan to evaluate injuries. Most chest injuries are managed conservatively but conditions like massive hemothorax or cardiac tamponade may require chest tube insertion or thoracotomy.
Thoracic trauma
Thoracic trauma is common, accounting for 50% of multiple trauma cases and 25% of trauma deaths. Potentially fatal thoracic injuries like tension pneumothorax, massive hemothorax, and cardiac tamponade require rapid recognition and intervention to save lives. The primary survey focuses on the "Deadly Dozen" immediate threats like airway obstruction, open pneumothorax, and flail chest, while the secondary survey evaluates less immediately life-threatening injuries like pulmonary contusion and myocardial contusion. Chest injuries frequently necessitate prompt treatment and often require urgent transport or "load-and-go" to definitive care.
Intestinal stomas
- Intestinal stomas are surgically created openings of the small or large intestine onto the abdominal wall. There are three main types: colostomy, ileostomy, and loop stoma.
- Complications include prolapse, herniation, stenosis, dermatitis from effluent, and obstruction. Dietary advice focuses on reducing gas, bulk and odorous foods. Management involves properly attaching collection bags and monitoring for complications.
Penetrating chest injury
1) Penetrating chest injuries can damage the chest wall, lungs, heart, blood vessels, diaphragm or mediastinum. Signs and symptoms depend on the specific organ injured but may include pain, difficulty breathing, shock or abdominal symptoms.
2) For penetrating injuries to the heart (cardiac tamponade or wound), management depends on the patient's hemodynamic stability. Unstable patients require immediate thoracotomy while stable patients can be evaluated first with ultrasound or surgery.
3) Surgical techniques for penetrating cardiac injury include median sternotomy or left lateral thoracotomy. The pericardium is opened to access the heart. Bleeding from ventricles is controlled manually or with s
Abdominal trauma
This document discusses approaches to managing abdominal trauma in the emergency department. It begins by outlining learning objectives which include identifying abdominal trauma, learning assessment approaches, and trauma management. It then discusses the primary and secondary surveys as well as indications of shock. Specific injuries like solid organ injuries, hollow visceral injuries, retroperitoneal injuries, and diaphragmatic injuries are examined. Mechanisms of injury, physical exam findings, ultrasound, and management are also reviewed to provide emergency physicians with guidance on evaluating and treating abdominal trauma.
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This document outlines the procedure for thyroidectomy. It begins with definitions and indications for thyroid surgery, which include toxic multinodular goiter and malignant thyroid tumors. It describes the types of thyroidectomy that can be performed and the pre-operative preparation, including rendering thyrotoxic patients euthyroid. The procedure involves an incision above the sternum, identification and preservation of the recurrent laryngeal nerve and parathyroid glands, ligation of vessels, and removal of the thyroid. Post-operative management includes monitoring for complications such as hemorrhage, nerve injury, and hypocalcemia.
Thoracic injury
Thoracic injuries account for a significant portion of trauma deaths. The leading cause of death from thoracic injury is hemorrhage. Immediately life-threatening thoracic injuries include tension pneumothorax, massive hemothorax, flail chest, and pericardial tamponade. These injuries require rapid diagnosis and treatment to prevent further deterioration. While many thoracic injuries can be managed non-operatively with oxygen, analgesia, and chest tube drainage, emergency thoracotomy may be necessary to control severe hemorrhage in the chest from injuries to organs like the heart or lungs. Proper investigation and management of thoracic trauma can prevent avoidable deaths.
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Thank you for the thorough management plan. Let me know if you need any other feedback!
Video assisted thoracic surgery (vats)
1. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure used to diagnose and treat illnesses of the lungs and chest cavity.
2. VATS involves making small incisions and inserting surgical instruments and a camera to allow the surgeon to see inside the chest. This avoids the need for large incisions.
3. VATS is used for procedures like lung biopsies, removal of parts of the lung, treatment of collapsed lungs, and draining fluid from the chest cavity. It offers benefits like less pain, shorter recovery time, and smaller scars compared to traditional open chest surgery.
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Chest trauma
This document provides an overview of chest trauma, including:
- Common injuries like pneumothorax, hemothorax, flail chest and their signs and symptoms.
- Assessment involves clinical exam, chest x-ray and ultrasound to detect injuries. Chest tube insertion can be both therapeutic and diagnostic.
- "Deadly dozen" life-threatening injuries from chest trauma include tension pneumothorax, cardiac tamponade, aortic disruption and others that often require emergency procedures or surgery.
- Management involves airway control, ventilation, chest tube drainage, analgesia and monitoring for complications like respiratory failure. Operative treatment is indicated for severe injuries or those not responding to initial management.
Chest trauma by dr.damodhar.m.v
This document discusses various types of chest trauma, including pneumothorax, hemothorax, flail chest, diaphragmatic injury, aortic tear, esophageal rupture, pulmonary contusion, and cardiac tamponade. It provides details on the procedures used to treat chest trauma, such as intercostal drains and tracheostomy. Chest trauma can be caused by blunt or penetrating mechanisms and accounts for 20-25% of trauma deaths. Clinical features, investigations, and management are described for each type of chest injury.
Post operative complications
This document discusses various post-operative complications organized into categories. It describes wound complications including seroma, hematoma, wound dehiscence, and surgical site infections. It also covers thermal regulation issues like hypothermia and malignant hyperthermia. Gastrointestinal complications involving ileus, bleeding, and leaks are outlined. Other complications discussed include DVT, pulmonary embolism, infections and fever, pulmonary issues, renal failure, cardiovascular events, neurological problems like stroke and delirium, and diabetic ketoacidosis. Prevention and management strategies are provided for each complication.
Damage control surgery
Damage control surgery (DCS) is an approach used for severely injured trauma patients that focuses on rapidly addressing life-threatening issues like hemorrhage rather than fully repairing anatomy. It aims to prevent the lethal triad of hypothermia, acidosis, and coagulopathy that can result from long operations and blood loss. Key aspects of DCS include temporary measures like packing bleeding liver injuries; stapling but not repairing some intestinal injuries; leaving unrepaired vascular injuries clamped; and rapidly closing the abdomen with clips rather than drains to allow reoperation once the patient is stabilized. The goal is definitive repair within 24 hours once the patient's physiology is corrected.
Chest Trauma
This document outlines the anatomy of the chest and describes various types of chest trauma, including blunt and penetrating injuries. It discusses the initial assessment and management of life-threatening injuries like tension pneumothorax, massive hemothorax, and cardiac tamponade. The document also covers procedures like needle decompression, tube thoracostomy, and emergency department thoracotomy that may be used to treat severe chest trauma. Overall, the document emphasizes the importance of promptly identifying and treating life-threatening injuries to the chest.
Chest trauma presentation
This document provides an overview of chest trauma. It begins by defining chest trauma as any injury to the chest, including the ribs, heart and lungs. Chest injuries are categorized as open or closed. Common causes are discussed, including blunt trauma from accidents or penetrating trauma from objects. Signs and symptoms, diagnostic tests, and specific injuries like pneumothorax are described. Treatment focuses on ABCs - airway, breathing and circulation while performing tests to evaluate cardiac and pulmonary function.
Ribs: To fix or not to fix?
Rib fractures are common injuries that can have significant morbidity and mortality. While several randomized controlled trials have shown benefits of surgical stabilization for flail chest injuries, national guidelines conditionally recommend rib fixation only for flail injuries. Recent large observational studies suggest mortality may be lower with surgery for flail chest. Further research is still needed to determine if surgical stabilization provides benefits for non-flail rib fractures.
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Chest trauma
This presentation discusses chest trauma. It begins with an introduction noting that the chest contains vital organs and thoracic trauma is a common cause of death. [It then provides details on the anatomy of the chest and classifications of blunt vs penetrating trauma.] It identifies the "Deadly Dozen" as the most life-threatening chest injuries requiring immediate treatment, including tension pneumothorax, massive hemothorax, and flail chest. [It also discusses several potentially life-threatening injuries requiring secondary survey, such as tracheobronchial disruptions.] Throughout, it emphasizes the importance of strict adherence to ATLS protocols to identify and treat deadly chest injuries.
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1) Flail chest occurs when three or more ribs are broken in two or more places, causing a segment of the rib cage to become detached from the rest.
2) The detached or "flail" segment loses its attachment to the chest wall and becomes free floating.
3) A characteristic finding is paradoxical movement, where the flail segment moves in the opposite direction of the rest of the chest wall during breathing.
4) This paradoxical movement can significantly impair breathing and cause injury to the underlying lung. Aggressive pain management and respiratory support are usually required for treatment.
chest injury.pptx, hemothorax# pneumothorax # management
This presentation covers anatomy of the respiratory system, mechanisms of breathing, classification and types of chest trauma, initial assessment of thoracic injuries, and nursing interventions. Key topics include defining rib fractures, flail chest, pneumothorax, cardiac tamponade, and aortic injury. Assessment and management of these thoracic injuries is discussed as well as nursing priorities like airway maintenance, analgesia, and respiratory support.
A discription of chest wall trauma in a clinical setting
This document discusses chest wall trauma and injuries. It begins by describing the anatomy of the thorax and chest wall. It then covers mechanisms and types of chest trauma including penetrating injuries from stab wounds or gunshots and blunt injuries from falls or car accidents. Common injuries from chest trauma are discussed such as rib fractures, pneumothorax, hemothorax, lung contusions, and flail chest. Diagnosis involves imaging like chest x-rays or CT scans. Treatment depends on the specific injuries but may include chest tube insertion, ventilation support, pain management, and surgery in severe cases like flail chest. Complications are also reviewed.
CHEST TRAUMA.pdf
A presentation that will help clinicians attain the basic diagnostic skills required to effectively manage patients.
Traumatic arrest
The document discusses the management of traumatic cardiac arrest. Key points include:
- Traumatic cardiac arrest has a very poor prognosis, usually caused by penetrating or blunt chest injuries.
- For blunt trauma patients, emergency thoracotomy is only recommended if they had witnessed cardiac arrest or hypotension on arrival.
- For penetrating chest injuries, emergency thoracotomy within 20 minutes of injury may be considered if signs of life were witnessed or if ECG activity is present.
- Initial management involves bilateral thoracostomies to relieve tamponade, control bleeding, and provide fluids and medications. Emergency thoracotomy may be attempted in select cases but survival rates are extremely low.
Penetrating chest trauma.pptx
Penetrating thoracic trauma can range from stable patients with few complaints to hemodynamically unstable patients requiring immediate intervention. Potential injuries include injuries to the chest wall, lungs, heart, great vessels, esophagus, and diaphragm. Life-threatening injuries that require rapid assessment and treatment include tension pneumothorax, open pneumothorax, massive hemothorax, cardiac tamponade, and massive hemothorax. Initial management involves the ABCs with consideration of adjuncts like chest tubes and consideration of urgent thoracotomy for control of bleeding from major vessels or repair of cardiac injuries.
1- Management of poly-trauma patient.pptx
A 28-year-old male was brought to the emergency room after a motor vehicle accident. He complained of chest pain, a forehead wound, and right forearm pain. Examination found he was conscious with stable vital signs. Chest x-ray revealed an abnormal aortic knob and widened mediastinum. CT angiogram confirmed a traumatic aortic tear. Despite treatment, his condition deteriorated with low blood pressure and increased pain. Aortography then definitively diagnosed aortic rupture, which requires urgent surgical repair for survival.
chestinjury-blunt-180324031430 (1).pdf
Chest trauma, especially blunt chest trauma, can cause many serious injuries. Some immediate life-threatening injuries include tension pneumothorax, massive hemothorax, flail chest, and cardiac tamponade, which must be rapidly diagnosed and treated to prevent death. Other potential life-threatening injuries like pulmonary contusion, aortic disruption, and cardiac injuries may not be immediately apparent but are important to identify through thorough examination and imaging tests. Proper clinical assessment and management according to guidelines like ATLS is crucial for patients with chest trauma.
Matters heart armc 7 11-2011
The document discusses aortic dissection, including:
1. It is a difficult diagnosis to make, often with delays in diagnosis. Imaging such as CT scans are important for diagnosis.
2. Treatment depends on the type - Type A usually requires urgent surgery while Type B is initially treated medically to control blood pressure and heart rate.
3. Factors such as intramural hematoma, classification (Stanford vs. DeBakey), and long term prognosis are reviewed. Early recognition and treatment are important due to the risk of complications.
Matters heart armc 7 11-2011
The document discusses aortic dissection, including:
1. It is a difficult diagnosis to make, often with delays in diagnosis. Imaging such as CT scans are most accurate for diagnosis.
2. Type A dissections involve the ascending aorta and require urgent surgery, while Type B can often be initially treated medically to control blood pressure and heart rate.
3. Risk factors include hypertension, connective tissue disorders, cocaine use, and family history. Atypical presentations can include abdominal pain, neurological symptoms, or syncope.
liver trauma.pptx
The liver is easily injured due to its friable parenchyma and fixed position in the abdomen. Blunt force trauma from motor vehicle accidents is the most common cause of liver injury. For stable patients, conservative non-operative management is preferred even for severe injuries. Complications may include bleeding, biloma, abscess, and necrosis which are treated with procedures like angiographic embolization. Unstable patients require emergent laparotomy and packing. Rare injuries to major blood vessels have high mortality even with experienced surgery due to technical challenges of vascular isolation.
chest truma Kamal.ppt
1) Chest trauma is predominantly caused by motor vehicle accidents and falls. The most common injuries are chest wall trauma and hemothorax.
2) Early deaths from chest trauma are often caused by airway obstruction, tension pneumothorax, massive hemothorax, or cardiac tamponade.
3) Initial assessment focuses on the ABCs with stabilization of life-threatening injuries like tension pneumothorax the top priority. Secondary surveys then identify and treat other injuries like simple pneumothorax, pulmonary contusion, and blunt cardiac injury.
Trauma and critical care
The document provides guidelines on the assessment and management of trauma patients in the pre-hospital setting. It emphasizes maintenance of airway, breathing, and circulation as top priorities, with rapid transport to a trauma center. Diagnostic techniques like focused assessment with sonography for trauma (FAST) exam and indications for intubation are outlined. Triage systems like revised trauma score (RTS) and injury severity score (ISS) are also summarized for evaluating patients and comparing outcomes.
Chest trauma guidelines for ER doctors
chest trauma is one of the leading cause of death in poly trauma patients. ER doctor should be aware of how to suspect and how to deal with life threatening conditions resulting from chest trauma
Dr radhey shyam(polytrauma management)
This document discusses the management of polytrauma patients. It defines polytrauma as injuries involving two or more major body systems. The goals of management are to save the patient's life, salvage limbs, and restore function if possible. A team approach is needed involving surgeons, physicians, and other specialists. The initial focus is a thorough primary survey and resuscitation to address life-threatening injuries like airway obstruction, hemorrhage, and spinal cord injury.
Chest 12. Chest Trauma.pptx
The document provides an overview of immediately life-threatening chest injuries. It classifies chest injuries as either immediately life-threatening or potentially life-threatening. The six immediately life-threatening conditions discussed in detail are airway obstruction, tension pneumothorax, open pneumothorax, massive hemothorax, pericardial tamponade, and tracheobronchial injuries. For each condition, the document outlines clinical presentation and emergency management strategies. It also discusses emergency department thoracotomy and provides indications and contraindications for its use.
Chest, Abdominal and Genitourinary Injuries
This document provides an overview of chest, abdominal, and genitourinary injuries. It discusses the anatomy and physiology of the chest and abdominal cavities. Key points include recognition of blunt versus penetrating chest and abdominal trauma. Chest injuries can involve the lungs and heart. Signs may include difficulty breathing, coughing up blood, and unequal chest rise. Abdominal injuries can damage solid organs like the liver or hollow organs like the intestines. Signs may include pain, guarding, bruising, or distention. Proper assessment and treatment focus on the ABCs, with priorities being control of bleeding and treatment for shock.
CHEST INJURY
This document provides an overview of chest trauma. It begins with the anatomy of the thorax and then discusses various types of chest injuries including pneumothorax, hemothorax, flail chest, cardiac tamponade, and traumatic aortic rupture. For each type of injury, the document describes the mechanism of injury, signs and symptoms, and treatment approaches. It emphasizes the life-threatening nature of many chest injuries and stresses the importance of rapid diagnosis and management.
Emergencythoracotomy 151105053500-lva1-app6892
This document discusses emergency thoracotomy for traumatic injuries. It outlines indications for the procedure including hemodynamic instability from penetrating chest injuries or cardiac tamponade. Steps of the procedure are described including making a clamshell incision, controlling hemorrhage, performing cardiac massage and aortic clamping. Outcomes are better for penetrating chest injuries with signs of life. Videos and references on the technique are also provided.
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chest injury.pptx, hemothorax# pneumothorax # management
chest injury.pptx, hemothorax# pneumothorax # management
A discription of chest wall trauma in a clinical setting
A discription of chest wall trauma in a clinical setting
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The document discusses trauma teams and their roles. It defines a trauma team as a multidisciplinary group that works together to assess and treat severely injured patients. A team approach has been shown to significantly reduce resuscitation times compared to individual doctors. The roles of trauma team members are outlined, as well as techniques for effective communication, briefing, handover, and speaking up if concerns arise. Statistics from Western Australia in 2015 show the most common causes of death for major trauma patients were head injuries and brain death. Overall mortality rates were lower than the national average.
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Arthrocentesis
Mr. Arthur Ritis, a 52-year-old man with diabetes, hypertension, and a history of gout, presented with a hot, swollen, and painful right knee for 24 hours. Examination found a warm knee with a large effusion and mild tenderness. Blood tests showed elevated white blood cell count and C-reactive protein. Arthrocentesis of the knee found cloudy yellow synovial fluid containing urate crystals on microscopy. This confirms the diagnosis of an acute gout attack in the knee requiring treatment.
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This document discusses the use of echocardiography during cardiac arrest and peri-arrest situations. It provides an overview of basic echo views that can be useful. Echo can help identify the cause of arrest such as tamponade, pulmonary embolism, or wall motion abnormalities. Findings on echo such as hypovolaemia or myocardial activity can help guide management decisions. The document reviews where echo fits within the ACLS algorithm and issues surrounding its use during cardiac arrest. It provides examples of echo findings that may indicate treatable versus non-treatable causes of arrest.
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The document discusses the goals of implementing a new Goals of Patient Care (GOPC) form across hospitals in Western Australia to improve end-of-life care and decision making. It provides background on the form's trial implementation at various sites. The new form aims to have goals of care discussions with patients or their surrogates to determine appropriate treatment based on probable outcomes, not just resuscitation status. It outlines the form's structure with sections on baseline information, goal of care selection, discussion summary, and extended use. The document emphasizes improving communication around goals of care and ensuring treatment aligns with patients' values and preferences.
Physiology Directed CPR
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Patient confidentiality must be maintained in the ED. Personal information about patients cannot be disclosed without consent, except in emergencies or if required by law. Duty consultants should be aware of any VIP patients but provide the same standard of care. Confidentiality must be respected even for those not under the practitioner's direct care. Mandatory notifications to regulatory bodies are required only for specific conduct issues. Advice can be sought from designated hospital staff if questions arise about disclosing information.
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Emergency Thoracotomy
- 1. Emergency Thoracotomy Johnny Iliff
- 3. Thoracic Trauma 25-50% of all traumatic injuries. Most thoracic trauma patients managed conservatively. Deterioration in pre-hospital or ED leads to Emergency Thoracotomy. “occurring either immediately at the site of injury, or in the emergency department or operating room as an integral part of the resuscitation process”.
- 4. Increased Chance of Survival Signs of life in the ED Penetrating>Blunt thoracic injury Stab wounds > Gun Shots Thoracic injuries: However, some studies suggest there is up to a 10% neurologically intact survival rate for patients with penetrating abdominal injury undergoing cross clamping of the descending aorta as part of emergency thoracotomy.
- 5. Aims of the procedure Resuscitation of a patient in extremis with a penetrating injury by: Release cardiac tamponade Control haemorrhage Perform open cardiac massage Cross clamp the descending thoracic aorta Control air embolism
- 6. Indications- Penetrating Injury Previously witnessed cardiac activity (pre-hospital or in-hospital) Unresponsive hypotension (SBP <70mmHg) despite vigorous resuscitation
- 7. Indications- Blunt injury Rapid exsanguination from chest tube (>1,500mL immediately returned) Unresponsive hypotension (SBP <70mmHg) despite vigorous resuscitation
- 8. Relative Indications Penetrating thoracic injury with traumatic arrest without previously without previously witnessed cardiac activity Penetrating non-thoracic injury (e.g. abdominal, peripheral) with traumatic arrest with previously witnessed cardiac activity (pre-hospital or in-hospital) Blunt thoracic injuries with traumatic arrest with previously witnessed cardiac activity (pre-hospital or in-hospital)
- 9. Contraindications Blunt injury without witnessed cardiac activity (pre-hospital) Penetrating abdominal trauma without cardiac activity (pre-hospital) Non-traumatic cardiac arrest Severe head injury severe multisystem injury Improperly trained team Insufficient equipment
- 10. Lorenz et al (1992 h t t p : / / i 0 . w p . c o m / s c g h e d . c o m / w p - c o n t e n t / u p l o a d s / 2 0 1 4 / 0 4 / e m e r g e n c y - t h o r Lorenz et al (1992 Hunt et al (2005)
- 12. Equipment- Thoracotomy tray in T2 Scalpel–—no. 10 blade Suitable retractor, such as Finochietto’s rib spreader, or Balfour abdominal retractor Lebschke’s knife and mallet, or Gigli saw Curved Mayo’s scissors Toothed forceps Large vascular clamps, such as Satinsky DeBakey aortic clamp Mosquito/Dunhill artery forceps Foley catheter Long and short needle holders Internal defibrillator paddles Sutures, Teflon pledgets, sternal wires
- 13. MAJOR TRAUMA CALL Anaesthetics Orthopedics General Surgeons Cardiothoracics Radiology
- 16. Procedure Intubated and Ventilated (Airway Doc and Nurse)- discussion for right main bronchus intubation *seek and treat Pneumothorax in Blunt chest trauma Fluid Resus with blood products (Circ Doc and Nurse) *Ultrasound if qualified staff available Mask, visor, scrub, gown and glove (Proceduralist) Appropriate area 15* head up- left arm abducted and lights on Prep area Incise through skin, subcut tissue in 5th Intercostal Space above 6th Rib- costochondral junction to MAL
- 17. Divide the muscle, periosteum and parietal pleura in one layer with scissors and blunt dissection Insert a rib-spreading retractor with the handle towards the axilla To extend the incision to the right side, use strong scissors, bone cutters or a Gigli saw to cut through the sternum and into the right fifth intercostal space, mirroring the incision above. TAMPONADE- Pericardiotomy- Anterior to Phrenic Nerve
- 19. CARDIAC DEFECT- Finger/Foley catheter with gentle traction to repair defect MAJOR ABDO HAEMORRHAGE or HYPOPERFUSION Cross clamp aorta- passage of NGT helps identify Oesophagus SIGNIFICANT LUNG LACERATION OR AOR EMBOLISM FROM BRONCHIAL_VASCULAR COMMUNICATION-Cross clamp Hilum Cardiac Arrest- Compression with paddles VF/VT- Shock 15-30J
- 26. Book a bed
- 27. When to Stop?? Irreparable damage Massive head injuries Pulseless electrical activity (PEA) Systolic BP<70after15-20mins Asystolic arrest
- 28. https://www.youtube.com/watch?v=8BlPxQI2C90 https://www.youtube.com/watch?v=A57ZB_J4FuY
- 29. Resources http://lifeinthefastlane.com/ed-thoracotomy-is-it-just-the-first-part-of-the-autopsy/ Hunt PA, Greaves I, Owens WA. Emergency thoracotomy in thoracic trauma — a review. Injury. 2006 Jan;37(1):1-19. Epub 2005 Apr 20. Review. PMID: 16410079. Lorenz HP, Steinmetz B, Lieberman J, Schecoter WP, Macho JR. Emergency thoracotomy: survival correlates with physiologic status. J Trauma. 1992 Jun;32(6):780-5; discussion 785-8. PMID: 1613839. http://www.trauma.org/index.php/main/article/361/ http://emedicine.medscape.com/article/82584-overview The Royal Hospital Melbourne http://clinicalguidelines.mh.org.au/brochures/TRM04.02.pdf