Thoracic trauma can result in serious injuries and accounts for over 25% of trauma deaths, with blunt trauma making up 70% of chest injuries mostly from motor vehicle accidents. Common thoracic injuries include rib fractures, pneumothorax, hemothorax, and injuries to the heart and great vessels which require stabilization of the airway, breathing, and circulation followed by diagnostic imaging and treatment of life-threatening injuries. Management involves establishing ABCs, treating tension pneumothorax and sucking chest wounds, and having a high index of suspicion to identify specific injuries like aortic injuries that require further evaluation.
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
CHEST INJURY- BLUNT/ Trauma Surgery
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on CHEST INJURY- BLUNT- an important topic in trauma. Even the blunt chest trauma can turn into penetrating one because of jagged edges of the broken ribs. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about pathophysiology, clinical approach, symptoms, signs, investigations, different individual types of Chest injuries and management of all the varieties of Chest injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of chest injury and should also be able to institute immediate lifesaving treatment to the patients if there is a need. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Chest injuries ranks 3rd after head injuries and extremity injuries in a case of multisystem trauma.It is of two types blunt chest trauma and peneterating chest trauma.The main cause of blunt chest trauma is road side accidents due to vehicles. Peneterating chest trauma is more dangerous and is common in war injuries and civilian terroism.In this ppp I have discussed some useful uncommon and important aspects of chest injuries
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
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
CHEST INJURY- BLUNT/ Trauma Surgery
Dear viewers,
Greetings from “Surgical Educator”
Today I have uploaded a video on CHEST INJURY- BLUNT- an important topic in trauma. Even the blunt chest trauma can turn into penetrating one because of jagged edges of the broken ribs. I haven’t talked elaborately but have included the essential minimum an undergraduate medical student should know. I have talked about pathophysiology, clinical approach, symptoms, signs, investigations, different individual types of Chest injuries and management of all the varieties of Chest injuries. My aim is, after watching this video all of you should be able to arrive at a correct working diagnosis of the type of chest injury and should also be able to institute immediate lifesaving treatment to the patients if there is a need. You can watch the video in the following links:
surgicaleducator.blogspot.com
youtube.com/c/surgicaleducator
Thank you for watching the video.
Chest injuries ranks 3rd after head injuries and extremity injuries in a case of multisystem trauma.It is of two types blunt chest trauma and peneterating chest trauma.The main cause of blunt chest trauma is road side accidents due to vehicles. Peneterating chest trauma is more dangerous and is common in war injuries and civilian terroism.In this ppp I have discussed some useful uncommon and important aspects of chest injuries
Splenic trauma - Causes, Complications, ManagementVikas V
Splenic Trauma - A detailed Presentation about Splenic Trauma, anatomy of the spleen, Causes of Trauma, Mechanism of Injury, Diagnosis, Management, Surgical management, Steps of Splenectomy, and Complications
Mediastinal injury includes cardiac, thoracic aorta, pulmonary vessels and SVC injury. Pelvic includes pelvic fracture. GI injury includes upper and lower GI injuries. Abdominal vascular includes abdominal aorta, IVC and other named vascular injury.
thoracic injury during trauma is one of most important life threaten that maybe occurred. so all of medical practitioner must learn and must do some primary survey
Similar to Surgery 6th year, Tutorial (Dr. Aram Baram) (20)
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Thoracic Trauma
• Thoracic trauma is responsible for more than 25% of
trauma deaths.
• Blunt trauma accounts for 70% of chest injuries and more
than 70% of these injuries result from Motor Vehicle
Accidents.
•
• Penetrating injuries: 60 to 70% are due to stab wounds.
• Chest wall and soft tissue are the most common locations
for both blunt and penetrating trauma.
• Less than 10% of blunt injuries and only 15 to 30% of
penetrating injuries require thoracotomy
• One in four cases with cardiothoracic trauma,
regardless of etiology, requires hospital admission. 2
3. Types
•Blunt 70% of chest injuries
• Penetrating 60 to 70% are due
to stab wounds.
3
4. Penetrating Trauma
• Injuries are uncommon in either elderly or pediatric
patients, but they remain one of the most common
causes of death from trauma in persons up to 40 years
of age.
• Low-velocity handguns, seen primarily in the civilian
population, transmit very little damage to surrounding
tissues.
• Conversely, much more damage and energy is
conducted along the path of high-velocity missiles,
usually associated with the military, but now often
seen in violent assaults as well.
4
5. Blunt Trauma
Accounts for 70% of chest injuries and more
than 70% of these injuries result from Motor
Vehicle Accidents.
Less than 10% of blunt injuries and
only 15 to 30% of penetrating
injuries require thoracotomy
5
6. Initial Assessment and Management
Primary survey
Resuscitation of vital functions
Detailed secondary survey
Definitive care
6
7. Pathophysiology of Chest Trauma
Is the derrangement in normal flow of air
and blood
hypovolemia
ventilation-
perfusion Inadequate oxygen
mismatch delivery to tissues
changes in
intrathoracic
pressure TISSUE
relationships HYPOXIA
7
8. THE PRIMARY SURVEY
Rapid and thorough performance of the “ABCs” is the standard.
This begins with traditional resuscitation as outlined by the American College
of Surgeons in the Advanced Trauma Life Support guidelines.
The airway must be controlled and breathing assessed and established
immediately if necessary.
Circulation must be supported through rapid establishment of reliable, large-
bore venous access and the initiation of fluid resuscitation.
The primary survey is performed to search for immediate life-threatening
injuries that could account for ventilation or hemodynamic instabilities,
which, if left uncorrected, could cause the acute demise of the patient.
These life-threatening injuries are listed in the table below:
8
10. The presentation depends on the mechanism of injury
and the organ systems injured.
• Thoraco-abdominal
injury
• Any wound below
nipples in front and
• Inferior scapula
angles dorsally
•Any penetrating wound such as this should be considered
to have an abdominal component until proven otherwise.
10
11. Diagnosing Thoracic Injuries
• The time of injury, mechanism of injury,
estimates of MVA velocity and deceleration,
and evidence of associated injury to other
systems (eg, loss of consciousness) are all
salient features of an adequate clinical history.
• Information should be obtained directly from
the patient whenever possible and from other
witnesses to the accident if available.
11
12. Inspection
• Chest Wall: look for signs of injury such as wounds
(sucking), contusions, abnormal movement (flail chest),
swellings, cyanosis, pallor, types of respiration…
• Neck: distended neck veins, subcutaneous
emphysema, swelling and cyanosis.
• Abdomen: scaphoid abdomen(diaphragmatic rupture)
or rocking horse ventilation(high cord injury).
Never forget the back
12
13. Physical Exam
• General examination: PR, RR, BP
• Palpation: tracheal position, tenderness, or
crepitus (surgical emphysema).
• Percussion: dullness for hemothorax and
hyperresonance for pneumothorax
• Auscultation: Equal breath sounds & air entry,
heart sounds, bowel sounds high in chest.
13
14. Imaging studies
• The chest radiograph (CXR) (PA& Lateral):
• ECG
• Focused Assessment for the Sonographic Examination
of the Trauma Patient (FAST).
• Chest CT scan
• Transthoracic echocardiography (TTE)
14
15. Angiography
Angiography remains the gold standard in the diagnosis of aortic transection or injuries to the
great vessels. Indications for Angiographic Studies for Potential Thoracic Injuries are:
1) High-speed deceleration injuries
2) Chest X-ray findings:
Widened mediastinum
Loss of aortic knob shadow
Tracheal or esophageal deviation to the right
Widening of paraspinal stripe and/or apical capping
Downward displacement of left mainstem bronchus
Obliteration of the aortopulmonary window
3) Fractured first rib, sternum, or scapula
4) Multiple rib fractures or flail chest
5) Massive hemothorax
6) Upper extremity hypertension
7) Unexplained hypotension
8) Pulse deficits or asymmetry
9) Systolic murmur
15
16. Pericadiocentesis:
Performed in the resuscitative
phase as a diagnostic or at
best a temporising modality
in cardiac tamponade.
Pericardiocentesis cannot be
relied on to diagnose cardiac
injuries in a trauma setting
because of high false positive
and false negative (10 to 20%)
rates. 16
17. Lab studies
• Blood type and cross match
• Arterial blood gas:
Arterial blood gas (ABG) analysis, though not as important in the initial assessme
of trauma victims, is important in their subsequent management.
• Serum chemistry profile: Urea , createnin, K,Na, Ca,…etc.
• Coagulation profile
The coagulation profile, including prothrombin time/activated partial
thromboplastin time, fibrinogen, fibrin degradation product, and D-dimer
analyses, can be helpful in the management of patients who receive massive
transfusions (eg, >10 U packed RBCs).
• Serum troponin levels
• Serum myocardial muscle creatine kinase isoenzyme levels.
• Serum lactate levels
17
19. Management
• Initial management
As always in trauma, management begins with establishing ABCs.
• Indications for emergency endotracheal intubation include apnea,
profound shock, and inadequate ventilation.
• Chest radiography is not indicated in patients with clinical signs of a
tension pneumothorax, and immediate chest decompression is
accomplished with either a large-bore needle at the second intercostal
space or, more definitively, with a tube thoracostomy.
• A sucking chest wound must be appropriately covered to permit
adequate ventilation and to prevent the iatrogenic development of a
tension pneumothorax.
19
20. Initial assessment and management
• Hypoxia is most serious problem - early
interventions aimed at reversing
• Immediate life-threatening injuries treated
quickly and simply - usually with a tube or a
needle
• Secondary survey guided by high suspicion for
specific injuries
20
21. SPECIFIC INJUERIES:
A. Chest wall Injuries
• 1. Fracture Ribs
• Fracture of the ribs is the most common blunt thoracic injury,
occurring in an estimated 39% of patients.
• Rib fractures represent an important indicator of trauma
severity. In general, the greater the number of ribs fractured,
the higher the patient’s morbidity and mortality.
• The number of ribs fractured has been significantly correlated
with the presence of hemothorax or pneumothorax, with
81% of patients having either condition if two or more ribs
were fractured.
• Fractures of the fourth through the ninth rib are associated
with injuries to the lung, bronchus, pleura, and heart,
whereas fractures below the ninth rib are indicative of
spleen, hepatic, or renal injuries.
21
22. Symptoms
• The main symptoms include pain, tenderness, and
possibly crepitus.
• An upright chest X-ray is the standard way to diagnose
fractures.
• After adjusting for severity of injury, comorbidity, and
presence of multiple rib fractures, elderly patients (>65
years old) with simple rib fractures still were five times
more likely to die compared with patients under age
65.
• First rib fracture has particular significance because of
the great force required for it to occur and the
likelihood that intrathoracic visceral injury also has
taken place
22
23. Treatment
• Once a haemopneumothorax and major skeletal
injuries are excluded, the management is mainly
for control of chest pain by
• Nalgesics mostly NSAIDS,
• intercostals blocks by local anesthesia, T.E.N.S
may be useful.
• Chest strapping or bed rest is no longer advised
and early ambulation with vigorous
physiotherapy (and oral antibiotics if necessary)
is encouraged
23
24. Flail Chest
• Free floating segment of ribs.
– 3 or more rib fractures broken in 2 places.
• Look for paradoxical chest wall motion
– Inhaleinward
– Exhaleoutward
• Decreased air entry.
24
25. Types of flail chest
• Anterior: Bilateral anterior fractures with
bilateral costochondral separation (15%) or
fractures of sternum with associated
costochondral separation (7%).
• Lateral: Multiple fractures on the same side
with or without costochondral separation
(73%) or fractures of several ribs with two or
more fracture points on the same side (5%).
25
26. Treatment:
• Approximately 50% of patients with flail chest can be managed without
mechanical ventilation with the use of epidural analgesia, chest
physiotherapy, bronchoscopy for mucus plugs, bronchodilators and
mucolytic agents and supplemental oxygen.
• Mechanical ventilation is used when signs of progressive hypoxia not
responding to simple oxygen therapy.
• In the more severe case, endotracheal intubation is required with
positive-pressure ventilation for up to 3 weeks, until the frac-tures
become less mobile.
• Thoracotomy with fracture fixation is occasionally appropriate if there is
an underlying lung injury to be treated at the same time.
• An anterior flail segment with the sternum moving paradoxically with
respiration can be stabilised by internal fixation but operative
management is not usual for either.
26
27. Sternal Fractures
• Most often in MVA.
• Incidence 3%.
• Normal vitals and normal EKG. Repeat EKG in
6 hrs and D/C if unchanged.
• Practice varies between institutions.
27
28. Subcutaneous Emphysema
• Air leak from lung parenchyma, or
tracheobronchial tree.
• Interstitial lung injury through hilum and
mediastinum.
• If extensive then suspect injury to
pharynx, larynx, or esophagus.
• Should be assumed that pt has
pneumothorax even if not visible on
chest x-ray.
28
30. Traumatic Pneumothorax
• Traumatic injury causes
laceration of the lung
parenchyma &/or
tracheobronchial tree and
air enters the pleural
space.
• Negative pressure in
pleural space facilitates air
escape
30
31. Traumatic Pneumothorax
Trauma
Simple Open or sucking Tension
pneumothorax. pneumothorax. pneumothorax.
32. Simple Pneumothorax
• Clinically the breath sounds are
decreased on the affected side
with a hyper resonant percussion
note.
• An erect CXR aids the diagnosis.
• Pneumothoraces <2cm from the
inner rib surface could observed
• If these patients decompensate,
or if pneumothorax enlarges or if
the patient needs ventilation,
tube thoracostomy should be
performed.
33. Tension Pneumothorax
• Develops when a "one way
valve" air leak occurs either
from the lung or through the
chest wall (Sucking wound).
• The mediastinum is displaced
to the opposite side leading to
decrease venous return and
compression of the opposite
lung and impaired ventilation
and end with circulatory
collaps.
• This is a clinical diagnosis and
treatment should not be
delayed by waiting for
radiologic confirmation.
35. Tension Pneumothorax
Tension pneumothorax is
characterised by
† air hunger,
† respiratory distress,
† tachycardia,
† hypotension,
† tracheal deviation to the
opposite side of injury,
† unilateral absence of breath Tension pneumothorax requires immediate
sounds, decompression and is managed initially by
† neck vein distention and rapid insertion of a large bore needle into the
2nd intercoastal space in the mid-clavicular
† cyanosis as a late line.
manifestation. Definitive treatment is tube thoracostomy via
a chest tube inserted in the safety triangle.
36. Chest Tube
Insertion:
should be in the “safe
triangle” is the triangle
bordered by the anterior
border of the latissimus
dorsi, the lateral border of
the pectoralis major muscle,
a line superior to the
horizontal level of the
nipple, and an apex below
the axilla.
36
37. Open Pneumothorax
A: Inspiration
Seen in patients with large chest wall
defects (Sucking wound), where the
area of the defect is 2/3 that of
tracheal diameter or is larger than the
area of glottic opening.
Air passes preferentially through the
chest defect with each respiratory
effort because air tends to follow the
path of least resistance through the
large chest wall defect.
B:Experation
39. Haemothorax
Haemothorax is a collection of blood in the
pleural space and may be caused by blunt
or penetrating trauma.
Most haemothoraces are the result of rib
fractures, lung parenchymal and minor
venous injuries, and as such are self-
limiting.
Less commonly there is an arterial injury
(intercostal or internal mammary vessels)
which is more likely to require surgical
repair. 39
40. Haemothorax
• Diagnosis is made on clinical examination by the
decreased breath sounds and dullness to
percussion on affected side.
• Confirmation is by CXR which shows complete or
partial opacification of the affected side.
• Chest tube thoracostomy is performed in the
safety triangle for haemothorax by wide-bore
tube (> 28French).
• Bleeding is classified as minimal (<350 ml),
moderate (350 to 500ml)
massive (>1500 ml).
41. Massive Hemothorax
• Each hemithorax can hold 40-50% of blood
volume.
• Defined: 1500 mL or more intial drainge.
• Cause: Injury to lung parenchyma, intercostal
artery or internal mammary artery
41
42. Which exam to request?
Hematological: To detecte
blood loss
Chest x-ray:
• Upright film (PA & Lat):
200-300 mL of blood.
• Supine film: >1000mL of
blood
42
43. Management
Chet tube : In 85% of the patients, > 32F
About 5-15% of pts admitted with chest
trauma require thorocotomy.
Indications of Thoracotomy:
1) The initial blood drainage is >1500ml.
2) When bleeding persists at a rate of 200
to 300ml per hour over 3 to 4 hours.
3) When there is haemodynamic
instability. 43
44. Pulmonary Contusion
• Occurs in 50 to 60% of patients with blunt trauma.
• Intrusion of ribs after frontal or lateral impact can cause direct damage injury to alveolar
lining, capillaries and lung parenchyma cause hemorrhage and cellular disruption.
• Grossly involved lung becomes hemorrhagic consolidated and oedematous irregular
patches.
• The resulting hypoxemia occurs 24 to 36 hours after injury.
• Localised contusion usually resolves without major sequelae. This process usually takes 10
to 14 days.
• Alternatively this may progress to varying degrees of ARDS in some patients.
Treatment:
• Supplement oxygen.
• Chest physiotherapy.
• Bronchodilators and mucolytics.
• Limit fluid administration.
• Steroids - use controversial.
• Antibiotics also controversial.
• Mechanical ventilation if indicated.
• Analgesics are strongly indicated
45. Diaphragmatic rupture
• The mechanism for diaphragmatic rupture is high-
speed blunt abdominal trauma with a closed glottis.
• The incidence is 1-3% of all chest trauma cases.
• The sudden rise in intra-abdominal pressure breaches
the weakest part of the abdominal wall, namely the
diaphragm.
• The injury to left diaphragm is 4 times commoner than
the right due to protection afforded by the liver on the
right.
46. Diaphragmatic rupture
• Bowel sounds may be heard in the chest and the chest
radiograph may reveal bowel gas in the lung fields.
• A plain chest x-ray with a NG tube in the stomach can
confirm the diagnosis or a contrast study.
• But if the patient has signs of acute abdomen the
repair to be by a laperatomy to deal with any intra-
abdominal injuries.
• Whilst chronic injuries (more than one month) should
be approached through the chest due to adhesions.
47. Oesophageal injury
• It should be noted whether the presentation after
injury is delayed >24hours as this affects
management.
• The majority of cases occur in the cervical region.
• The clinical suspicion is heightened by the
association of fever, pain in the neck and
tachycardia (Makler’s triad), crepitus and a
“mediastinal crunch” may be heard on
auscultation.
• Contrast radiography could be performed by
Gastrografine.
48. Management
Early diagnosis :
An NG tube should be passed and IV prophylactic antibiotics
started. A right sided thoracotomy is used for the middle 1/3
oesophageal injury. The lower 1/3 is better approached via the
left side of the chest.
Delayed presentation:
Primary closure is often not possible due to florid sepsis. Options
open to a surgeon are:
• Tube drainage and oesophageal suction
• T-tube insertion in perforation
• Cervical oesophagostomy and distal ligation
• Oesophageal resection
The mortality for delayed presentation is +/-25%
49. Cardiac Tamponade
• Is impairment of ventricular filling due to
increased intrapericardial pressure due an
increase in the intrapericardial content such
as blood and/or effusions.
• Unless recognized and treated promptly
cardiac tamponade can be fatal.
• The pericardial space normally contains 20-50
mL of fluid.
50. Cardiac Tamponade
• Rapid accumulation of as little as 150 mL of
fluid can result in a marked increase in
pericardial pressure and can severely impede
cardiac output.
• Approximately 2% of penetrating injuries are
reported to result in cardiac tamponade
51. Diagnosis
• Beck’s Triad: (hypotension, jugular venous
distention, and muffled heart sounds) occurs in
only 10% to 40% of patients.
• Pulsus paradoxus also paradoxic pulse This is an
exaggeration (>12 mm Hg or 9%) of the normal
inspiratory decrease in systemic blood pressure..
• Kussmaul’s sign, or paradoxical inspiratory
distention of neck veins upon expiration, is
another classic sign attributed to pericardial
tamponade.
• FAST is rapid and accurate method of diagnosis
52. Cardiac Tamponade
• A clinical syndrome caused by the accumulation of
fluid in the pericardial space, resulting in reduced
ventricular filling and subsequent hemodynamic
compromise.
• The overall risk of death depends on the speed of
diagnosis, the treatment provided, and the
underlying cause of the tamponade.
52
53. Cardiac Tamponade
• Caused by blunt and penetrating trauma.
• Stab wounds to midchest most common cause.
• Pericardial sack has poor compliance.
• Normally it contains 20-50 mL of fluid.
Only 150-200 mL can result in tamponade.
53
54. Cardiac Tamponade
• History:
• Symptoms vary with the underlying cause and
the acuteness of the tamponade.
• Patients with acute tamponade may present
with dyspnea, tachycardia, and tachypnea.
• Cold and clammy extremities from
hypoperfusion are also observed in some
patients.
54
56. Pericardiocentesis
• Paraxiphoid approach
• Can direct needle toward
left scapula or right scapula
(less likely to damage
ventricle).
• Up and back at 45 degrees
for 4-5 cm.
• Aspirate every 1-2mm.
• Removal of 5-10 mL can
increase stroke volume by
25-50%. 56
57. COMPLICATIONS OF THORACIC TRAUMA
Pulmonary Pleural Space Vascular
Atelectasis Empyema Thromboembolism
Acute respiratory Bronchopleural Air embolism
distress fistula
syndrome/acute lung
injury
Pneumonia Organized Pseudoaneurysm
hemothorax
Infarction Chylothorax Great vessel fistula
Lung abscess Fibrothorax Vascular
Arteriovenous fistula Diaphragmatic Thromboembolism
hernias
Bronchial stenosis Pleural Space Air embolism