Chest trauma

1. Thoracic Trauma
Bawantha Gamage
Senior Lecturer in Surgery

2. Thoracic Trauma
Objectives
To discuss the types and pathophysiology of
thoracic injuries
To discuss the principles of management

3. Types
• Direct injuries
penetrating
blunt
• Indirect
blast
deceleration

6. Consequences of Chest injury :
- Associated neck & Abdominal injures
• Effect on the respiratory function
• Effect on haemodynamic function

7. Effect on Respiratory function
• Chest wall injury
Fracture ,contusion, flail
• Pulmonary,tracheo bronchial injury
Contusion, collapse , mediastinal shift
HYPOXIA - ACIDOSIS

8. Effect on the haemodynamic function
• Blood loss
Intercostal , internal mammary
lung paranchyma,pulmonary hilum
aortic trnsection
cardiac injury

9. Immediately life threatening chest injuries
• Tension Pneumothorax
• Open Pneumothorax
• Massive Haemothorax
• Flail chest
• Cardiac Temponade

10. Tension Pneumothorax
• What is the mechanism ?
• How does it differ from open pneumothorax ?
• How do we recognise ?
• How do we treat ?

14. Massive haemothorax
• Loss of more than 1000 ml of blood in to chest
cavity or in to the drain
• Loss of more than 200 ml per hour for 3 hrs
• Continued brisk bleeding.( >100ml/15min )
• Treatment
decompression , replacement,
control of the source
HYPOTENSIVE RESUSCITATION

16. Flail chest
• Loss of continuity of a segment of chest
wall
• Clinical diagnosis
• Associated haemothorax,pneumothorax
pulmonary contusion
• Drain, intubation + ventilation (IPPV)
and pain relief

18. Cardiac Temponade
• Beck s triad
 Distended neck veins
 Hypotension
 Muffled heart sounds
Treatment
Pericardeocentesis
+
Emergency Thoracotomy

20. Indications for Emergency Thoracotomy
 Uncontrollable haemorrhage
• Loss of more than 1000 ml of blood in to chest
cavity or in to the drain
• Loss of more than 200 ml per hour for 3 hrs
• Continued brisk bleeding.( >100ml/15min )
 Cardiac Temponade
85% chest injuries can be managed
without major surgery

21. Potentially life threatening chest injuries
 Pulmonary contusion
 Myocardial contusion
 Aortic Transection
 Diaphragmatic injury
 Oesophageal trauma

22. Principles of management
 Primary and Secondary survey
 Hypotensive resuscitation
 Drain ,replacement ,ventilation,
analgesia, monitoring
 Recognition of injuries – Xrays, MRI, Angio
 Limited role of Emergency Thoracotomy

23. Summary
• Affects respiratory and haemodynamic
status
• Identification and treatment of immediate
life threatening injuries will reduce the
morbidity and mortality
• 85% will need IC Tube drainage only

24. Thank You
Please note that the photos were obtained from Google pictures