The document discusses various types of chest injuries that can result from blunt or penetrating trauma. It describes injuries to the chest wall like rib fractures, as well as injuries within the thoracic cavity including pneumothorax, hemothorax, lung contusions, and injuries to the heart and major blood vessels. The majority of chest trauma can be managed with supportive care like oxygen therapy, analgesics, and chest tube drainage, while a minority of severe cases require surgical intervention like thoracotomy.

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4.  Defn: Injury to one/more components of
 Chest wall
 Thoracic cavity Organs
Chest wall injuries
1. Rib Fracture & Flial chest
2. Clavicular,Scapular,Sternal Fracture
3. Surgical Emphysema
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6.  Pleural space injuries
Pneumothorax
Hemothorax
Chylothorax
 Lung parenchyma injuries
Pulmonary contusion
Pulmonary hematoma
 Tracheobronchial injuries
 Cardiac injuries
Tamponade
Contusion
Ventricular rupture
 Great vessel injuries
 Esophageal injuries
 Diaphragmatic injuries
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8.  25% of all trauma deaths
 Blunt Vs Penetrating
 90% can be managed by simple measures.
 Oxygen therapy
 Analgesics
 Chest physiotherapy
 IV fluid replacement
 Chest tube drainage
 Only 10% require major Surgery
Thoracotomy
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9. 1. Blunt
• Direct blow
• Deceleration
injury
• Compression
injury
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10. 2. Penetrating
 Gun shots
 Stabs
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11. Pathophsiology Mechanisms
 Hypoxia
 Hypercarbia
 Acidosis
 Hypotension
Pain
Blood loss
↓ed Venous
Return
Lung comprn.
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12.  Most common blunt injury
 4-10 ribs commonly fractured
 Post. Angle common # site
 No of #ed Ribs ≈ Degree of underlying injury
 Uncommon in children
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13.  1st & 2nd rib #
 Excessive energy transfer
 Suspect associated injury
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14. Lower ribs # : Liver & Splenic injury
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15.  Diagnosis
 Localised pain, tenderness, crepitus
 CXR - to exclude other injuries
 Treatment
1. Strong analgesics
2. Encourage breathing
3. Treat associated injuries
4. Do not strap the chest
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16.  Multiple rib fractures at two sites
 3 or more ribs , each #red at 2 places
Anterior & Lateral
 Causes paradoxical chest movement &
Ventilation Perfusion mismatch.
 Significant force required & associated with severe lung
injury
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18. Main insult ► underlying lung injury
► associated injury
Dx - severe chest pain, dyspnea
- decreased O2 saturation
- paradoxically moving chest
segment
- CXR - multiple #
- underlying lung
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19.  Rx
 Pain control
- O2 supplementation
Stabilize the flail segment
Firm gentle manual pressure
 Apply IV/sand bags
 Place patient with injured site down
• Mechanical Ventilation
• For severe cases with Lung contusion
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20.  Air between the visceral & parietal pleura (pleural
cavity)
 Effects are:
 Collapse of lung
 Mediastinal shift  Vena caval obstruction
 Hypoxemia & Hypovolaemia
 Classified as
 Spontaneous Vs Traumatic
 Open Vs Closed
 Simple Vs Tension
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22. Defect in chest wall communication
between pleural space & atmosphere.
By penetrating injury
Ipsilateral Lung collapse
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23.  C/Fs.:- R.D → Hemodynamic instability
-”sucking” wound
 Also called Sucking chest wound
 Rx:
Three way dressing
Chest tube
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25. Air enters pleural space under pressure & cannot
escape
A real surgical emergency: Fatal
Dx- CLINICAL (Beck’s Triad)
 Distended neck veins
 Hypotension
 Muffled heart sound
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26. Rx
Immediate needle
decompression
Chest tube
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28. Blood between visceral & parietal pleura.
Bleeding from:
 Intercostal vessels
 Internal mammary vessels
 Lung parenchyma
Effects:
 Hypovolaemia & Lung compression
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29. Clinically:
 Hypovolaemia
 Absence of breath sounds
 Dullness to percussion
CXR: fluid collection
Rx
Chest tube insertion
Thoracotomy (massive hemothorax)
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30.  Rare comp. of chest trauma
 Manifests late :- 2-10 days
 Causes : - Hyperextension of spine
- Crush injuries
 Dx- Clinical / CXR / Pleural Tap
 Rx: Low fat diet
 Chest drain : - 3 – 4 weeks
 Thoracotomy & ligation
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31. Highly fatal
Penetrating → Stab & GSWs
Blunt → MVA
Frequency:- RV→LV→RA→LA
Presentation:-
• Cardiac Tamponade
• Myocardial Contusion
• Ventricular Rupture
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32.  Blood in the pericardial sac
 Mostly penetrating injuries
 Classically, Beck’s triad:
distended neck veins
muffled heart sounds -
hypotension
Rx:
 Volume resuscitation
 Pericardiocentesis
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