Chest injuries, complications and management pptx

Common chest injuries and its complications

1. Chest injuries By dr tj mbbs

2. Outline To have knowledge of the types of chest Management of chest injuries and their complications

3. Injury to the chest Ventilation of the lungs depends on a patent main airways, pulmonary alveoli, the rigid bony skeleton of the thorax and integrity of the nerves and muscle that control the movement of the ribs and diaphragm. Traumatic disruption of the chest wall is likely to be lethal

4. Continue………. Blunt trauma may: Rupture the main bronchus and the aorta Contuse the lungs and papillary muscles of the heart Damage coronary arteries

5. Fractures of the ribs Clinical features Pain Tenderness Usually caused by a direct blow and most commonly affected ribs are the seventh, eighth and nineth in the region of the midaxillary line.

6. Continues………. Special investigations Chest x-ray Bone scans

7. Continue………. Treatment and management of simple rib fracture Pain relief Vigorous physiotherapy No chest strapping because it inhibits thoracic movement and encourages pulmonary collapse

8. complications Flail chest The whole sternum is loosened by fractured ribs on either sides or Several ribs are fractured in two places There are paradoxical chest movement The patient becomes grossly hypoxic

9. Continue……….

10. Continue………. Treatment and management of flail chest Support the flail chest Endotracheal intubation and positive-pressure ventilation tracheostomy

11. Continue……… Pneumothorax / tension pneumothorax Results if the pleural tear is valvular by allowing air to be sucked into the pleural cavity at each inspiration by preventing air returning to the bronchi on expiration.

12. Continue………

13. Continue………. Signs and symptoms Dyspnoea Displaced apex beat and trachea away from affected side Cardiac dullness may be absent Hyper-resonant percussion note on affected side Intercoastal spaces bulging

14. Continue………. Treatment and management Needle decompression Chest drain Thoracotomy repair

15. Continue………. Subcutaneous (surgical) emphysema A fractured rib tears the overlying soft tissue and allows air from pneumothorax to enter the subcutaneous tissue Signs and symptoms Swelling of face and neck Crackling feel to the examining fingers (crepitations) Managed conservatively

16. Continue………. Sucking wound of the chest A pneumothorax will also result from a penetrating wound of the chest wall produced by a knife stab or gunshot The lips of the wound may also have a valvular effect whereby air is sucked into the pleural cavity at each inspiration Treatment and management Closed by either suturing or dressing pad in an emergency Wound toilet and underwater intercostal drain Formal exploration

17. Continue………. Haemothorax / massive haemothorax Patient may have haemopneumothorax The bleeding is usually from an intercostal artery or contused lung On occasions may result from injury to the heart or great vessels Retropleural bleeding may compress the thoracic viscera without breaching the pleural cavity

18. Continue……… Treatment and management Chest drain Exploratory thoracotomy

19. Continue………. Traumatic asphyxia Severe crush injuries of the chest produces bruises and petechial haemorrhages over the head, neck and trunk Other visceral injury Penetrating chest injury may injure diaphragm, liver and spleen Incorrect placement of chest drain may also do the same

20. Continue……… Cardiac tamponade May follow open or closed injuries to the chest or upper abdomen Signs and symptoms Rise in venous pressure Fall in arterial pressure Muffled heart sound

21. Continue………. Investigation Chest x-ray Cardiac-echo Treatment and management Surgical exploration Pericardium opening The blood evacuation The cardiac laceration suturing

22. General management of chest injuries Airway control Breathing Circulation Disability Exposure

23. references General surgery lecture notes 12 th edition

24. Pre-reading assignment Definition of shock, types of shock and management of shock

25. Au revoir