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THORACIC TRAUMA AND
RESUSCITATION
Dr. Syed Junaid Shah
MCPS, FCPS-II Trainee
Department of Anaesthesia, SICU and Pain Management
Dr. Ruth K. M. Pfau Civil Hospital Karachi
E
T
I
O
L
O
G
Y
A 36-year-old male helmeted patient was transferred from an outside
hospital following a high speed motorcycle accident in which he
collided with another vehicle. Prior to transfer, the patient had a
reported GCS of 14, was hemodynamically stable, and had suffered
multiple rib and lower extremity fractures. Upon arrival to our trauma
center, he became unresponsive and tachycardic and had a blood
pressure of 56/42.
TYPES OF THORACIC INJURIES
DIRECT
INJURY
BLUNT
TRAUMA
PENETRATING
TRAUMA
INDIRECT
INJURY
BLAST
DECELERATION
HOW TO PROCEED?
PATHOPHYSIOLOGY OF TENSION
PNEUMOTHORAX
BECK'S TRIAD
THANK YOU

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THORACIC INJURY Dr Junaid Shah.pptx

  • 1. THORACIC TRAUMA AND RESUSCITATION Dr. Syed Junaid Shah MCPS, FCPS-II Trainee Department of Anaesthesia, SICU and Pain Management Dr. Ruth K. M. Pfau Civil Hospital Karachi
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  • 5. A 36-year-old male helmeted patient was transferred from an outside hospital following a high speed motorcycle accident in which he collided with another vehicle. Prior to transfer, the patient had a reported GCS of 14, was hemodynamically stable, and had suffered multiple rib and lower extremity fractures. Upon arrival to our trauma center, he became unresponsive and tachycardic and had a blood pressure of 56/42.
  • 6. TYPES OF THORACIC INJURIES DIRECT INJURY BLUNT TRAUMA PENETRATING TRAUMA INDIRECT INJURY BLAST DECELERATION
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Editor's Notes

  1. Bismillah ir rehman nir Raheem. Im Dr. sayed junaid shah year 2 fcps part 2 trainee from department of anesthesia, pain management and surgical icu dr ruth km pfau civil hospital Karachi. Today topic of my presentation is thoracic trauma
  2. So the epidemiology shows thoracic trauma is second most common cause of death after head trauma. And it is approximetly 10-20% of polytrauma.
  3. Deaths occur within first 4 hours of thoracic trauma is due to hemorrhage , hypoxia and delay intwerventions due to delayed identification
  4. Etiology graph shows maximum cases of thoracic injuries are due to road traffic accident
  5. So here is a case of A 36-year-old male helmeted patient was transferred from an outside hospital following a high speed motorcycle accident in which he collided with another vehicle. Prior to transfer, the patient had a reported GCS of 14, was hemodynamically stable, and had suffered multiple rib and lower extremity fractures. Upon arrival to our trauma center, he became unresponsive and tachycardic and had a blood pressure of 56/42.
  6. As per classification there are two broader classes direct injury and indirect i
  7. Trauma to thorax causes problems in respiratory and hemodynamic function
  8. SO YOU CAN SEE all MAJOR ORGANS AND VESSELS , which can be injured due to trauma
  9. So these are the injuries related to airway and major vessels
  10. Again these all can be damaged in thoracic trauma
  11. Pathophysiology of death related to thoracic injury is due to hypoxia caused by hypoventilation and hypotension
  12. How to proceed with a pt of thoracic trauma
  13. As discussed in earlier presentations.. Advanced trauma life support is to be followed in every trauma patients. Primary survey and secondary survey. ABC
  14. Primary survey includes examination of Airway,(upper and lower) ribs and joint fractures
  15. Breathing abnormality is a key finding for any thoracic injury. It can be labored, paradoxical, recessions can be seen. On palpation you can identify emphysema or rib fracture
  16. So in review of management we will do all these
  17. IDENTIFY THESE IN PRIMARY SURVEY ASSESS AIRWAY BREATHING CICULATION BASIC ATLS FOR THORACIC TRAUMA ALSO ASESS RESPIRATION (LABOURED/HYPOPNEA/TACHYPNEA) ASSESS BREATHING ASSESS CHEST WALL FOR WOUND CONTUSIONS ASSES NECK FOE EMPHYSEMA OR HEMATOMA ASSESS BACK ASSESS RIBS NOTICE THESE LIFE THREATNING INJURIES THAT NEEDS IMMEDIATE ATTENSION
  18. This is how we identify different lifethreatening injuries of thorax by history, meticulous examination and assesment
  19. If a patient comes in shock you have to evaluate
  20. Fractured rib, punctured pleura air started to accumulate in pleural space that causes lung to collapse and shift of mediastinum that leads to hypoxia and hemodynamic collapse
  21. Cxr shows jet black shadow and a collapse lung border with shifting of mediastinum in tension pneumothorax
  22. Chest tube insertion in mid axillary line in 5th intercoastal space. Analgesia is of prime importance for any thoracic injury
  23. This how needle thoracostomy is done
  24. Air goes in can not coming out effectively causes lung to collapsed and compromised respiration
  25. PAIN MANAGEMENT AND PROMPT PHYSIOTHERAPY IS ALSO INDICATED
  26. Definitive chest tube insertion and hemodynamic resucitation
  27. pathophysiology
  28. It will be discussed in upcoming lectures, but emphasizing here its prime importance. Better pain control can save a life
  29. On basis of hx, examination and investigataion .. Decide your pain management technique
  30. These are diff modalities. Gold standard is epidural. But researches are ongoing for unilateral block techniques
  31. Thank you for listening, all questions and comments are welcomed