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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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Thoracic trauma
- 1. Barry Kidd 20101 Thoracic Trauma
- 2. Barry Kidd 20102 Overview Major signs and symptoms • Immediate life-threatening injuries Pathophysiology and management • Open pneumothorax • Tension pneumothorax • Massive hemothorax • Flail chest • Cardiac tamponade Cardiac involvement with blunt injury Other thoracic injuries 2Thoracic Trauma -
- 3. Barry Kidd 20103 Thoracic Trauma Thoracic injury is common. • 50% of multiple trauma • 25% of trauma deaths Potentially fatal thoracic injuries saved by rapid recognition and intervention. • Many require surgical intervention 3Thoracic Trauma -
- 4. Barry Kidd 20104 Chest Anatomy 4Thoracic Trauma -
- 5. Barry Kidd 20105 Mechanism of Injury Blunt • Direct compression Fracture of solid organs Blowout of hollow organs • Deceleration forces Tearing of organs and blood vessels • Direct trauma to organ and vasculature • Energy transmitted from mass and velocity 5Thoracic Trauma -
- 6. Barry Kidd 20106 Tissue Hypoxia Inadequate oxygen delivery Hypovolemia Ventilation/perfusion mismatch Pleural pressure changes Pump failure 6Thoracic Trauma -
- 7. Barry Kidd 20107 Thoracic Trauma 7 Shortness of breath Chest pain Hemoptysis (the coughing up of blood from the respiratory tract) Cyanosis Neck veins distended Tracheal deviation Asymmetrical movement Signs and symptoms Thoracic Trauma - Chest wall contusion Open wounds Subcutaneous emphysema Shock Tenderness, instability, crepitation (TIC) Breath sounds abnormal
- 8. Barry Kidd 20108 Primary Survey “Deadly Dozen” 1. Airway obstruction 2. Open pneumothorax 3. Flail chest 4. Tension pneumothorax 5. Massive hemothorax 6. Cardiac tamponade 8Thoracic Trauma -
- 9. Barry Kidd 20109 Secondary Survey “Deadly Dozen” 7. Myocardial contusion 8. Traumatic aortic rupture 9. Tracheal or bronchial tree injury 10. Diaphragmatic tears 11. Esophageal injury 12. Pulmonary contusion 9Thoracic Trauma -
- 10. Barry Kidd 201010 Primary “Deadly Dozen” Airway obstruction • Secondary hypoxia Common cause of preventable death Foreign body, tongue, aspiration • Always assume cervical spine injury 10Thoracic Trauma -
- 11. Barry Kidd 201011 Open pneumothorax • “Sucking chest wound” Air enters pleural space Ventilation impaired Hypoxia results • Signs and symptoms Proportional to size of defect 11Thoracic Trauma - Primary “Deadly Dozen”
- 12. Barry Kidd 201012 Open pneumothorax • “Sucking chest wound” Air enters pleural space Ventilation impaired Hypoxia results • Signs and symptoms Proportional to size of defect 12Thoracic Trauma - Primary “Deadly Dozen”
- 13. Barry Kidd 201013 Open pneumothorax • Close chest wall defect • Load-and-go 13Thoracic Trauma - Primary “Deadly Dozen”
- 14. Barry Kidd 201014 Flail chest 14Thoracic Trauma - Primary “Deadly Dozen”
- 15. Barry Kidd 201015 Flail chest • Assist ventilation • Load-and-go • Stabilize flail segment • Monitor for: Pulmonary contusion Hemothorax Pneumothorax 15Thoracic Trauma - Primary “Deadly Dozen”
- 16. Barry Kidd 201016 Tension pneumothorax • Dyspnea • Anxiety • Tachypnea • Distended neck veins • Tracheal deviation (rare) • Breath sounds diminished Hypertympany if percussed • Shock with hypotension 16Thoracic Trauma - Primary “Deadly Dozen”
- 17. Barry Kidd 201017 Massive hemothorax • Anxiety and confusion • Neck veins Flat: hypovolemia Distended: mediastinal compression • Breath sounds decreased Hypotympany if percussed • Shock 17Thoracic Trauma - Primary “Deadly Dozen”
- 18. Barry Kidd 201018 Massive hemothorax • Load-and-go • Treat for shock • Monitor for: Hemopneumothorax 18Thoracic Trauma - Primary “Deadly Dozen”
- 19. Barry Kidd 201019 Cardiac tamponade • Beck’s triad Hypotension Neck veins distended Heart sounds muffled • Paradoxical pulse • Breath sounds equal 19Thoracic Trauma - Primary “Deadly Dozen”
- 20. Barry Kidd 201020 Cardiac tamponade • Load-and-go • Treat for shock • Monitor • Monitor for: Hemothorax Pneumothorax 20Thoracic Trauma - Primary “Deadly Dozen”
- 21. Barry Kidd 201021 Secondary “Deadly Dozen” Myocardial contusion •Most common cardiac injury Blunt anterior chest injury • Same as myocardial infarction Chest pain Dysrhythmias Cardiogenic shock (rare) • Treat as cardiac tamponade 21Thoracic Trauma -
- 22. Barry Kidd 201022 Secondary “Deadly Dozen” Traumatic aortic rupture •Most common cause of immediate death Motor-vehicle collisions or falls from heights 90% die immediately • Scene Size-up and history extremely important No obvious sign of chest trauma Hypertension in upper extremities and hypotension in lower extremities (rare) 22Thoracic Trauma -
- 23. Barry Kidd 201023 Secondary “Deadly Dozen” Tracheal or bronchial tree injury •Subcutaneous emphysema (Subcutaneous emphysema can often be seen as a smooth bulging of the skin. When a medic palpates the skin, an unusual crackling sensation can be felt as the gas is pushed through the tissue) Chest, face, neck • Ensure adequate airway • Monitor for: Pneumothorax Hemothorax 23Thoracic Trauma -
- 24. Barry Kidd 201024 Secondary “Deadly Dozen” Diaphragmatic tear (a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in respiration) • Severe blow to abdomen • Herniation of abdominal organs More common on left Breath sounds diminished Bowel sounds auscultated in chest (rare) Abdomen appears scaphoid 24Thoracic Trauma -
- 25. Barry Kidd 201025 Secondary “Deadly Dozen” Esophageal injury • Penetrating trauma • Difficult to assess in field • If unrecognized, may be lethal 25Thoracic Trauma -
- 26. Barry Kidd 201026 Secondary “Deadly Dozen” Pulmonary contusion • Common from blunt trauma • Hours to develop • Marked hypoxemia Impaled object • Do not remove • Gently stabilize object • Avoid movement 26Thoracic Trauma -
- 27. Barry Kidd 201027 Other Chest Injuries Traumatic asphyxia • Severe compression • Ruptures capillaries Cyanosis above crush Swelling of head, neck Swollen tongue, lips Conjunctival hemorrhage 27Thoracic Trauma -
- 28. Barry Kidd 201028 Other Chest Injuries Simple pneumothorax • Fractured ribs • Pleuritic chest pain • Dyspnea • Decreased breath sounds • Hypertympany if percussed • Monitor for: Tension pneumothorax 28Thoracic Trauma -
- 29. Barry Kidd 201029 Other Chest Injuries Sternal fracture • Significant blunt trauma to anterior chest • Signs of fracture on palpation • Myocardial contusion presumed Simple rib fracture • Most frequent chest injury • Monitor for: Pneumothorax Hemothorax 29Thoracic Trauma -
- 30. Barry Kidd 201030 Summary Chest injuries common Often life-threatening • Require prompt recognition • Require prompt intervention • Frequently require load-and-go Airway and oxygenation always priority Frequent Ongoing Exams 30Thoracic Trauma -
- 31. Barry Kidd 201031 Discussion 31Thoracic Trauma -
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