chest trauma and management presentation

chest trauma and management

1. Approach to Chest Trauma Based on Sabiston Textbook of Surgery, 21st Edition (pp. 386–425) Prepared by: [Your Name] Department of Surgery

2. Learning Objectives 1. Understand the epidemiology of chest trauma. 2. Review initial assessment and management. 3. Identify life-threatening injuries. 4. Discuss investigations and imaging. 5. Review surgical and ICU management.

3. Epidemiology • Chest trauma accounts for 25–50% of trauma deaths. • Blunt trauma: ~70–80% of cases. • Penetrating trauma: gunshot, stab, impalement. • Common in MVCs, falls, crush injuries.

4. Mechanism of Injury • Blunt: rapid deceleration, compression, crush. • Penetrating: direct tissue disruption. • Blast: overpressure + secondary projectiles.

5. Initial Assessment (ATLS) Follow ABCDE approach: A – Airway with cervical spine protection B – Breathing and ventilation C – Circulation with hemorrhage control D – Disability (neurologic status) E – Exposure and environment control

6. Life-Threatening Injuries • Tension pneumothorax • Open pneumothorax • Massive hemothorax • Flail chest • Cardiac tamponade • Air embolism

7. Investigations • Chest X-ray: initial, portable. • FAST / E-FAST: hemothorax, pericardial effusion. • CT scan: detailed evaluation. • Angiography for vascular injury.

8. Management Principles • Ensure airway and oxygenation. • Insert chest tube (tube thoracostomy) for pneumothorax/hemothorax. • Fluid and blood resuscitation. • Thoracotomy if ongoing bleeding or cardiac arrest from chest injury.

9. Specific Injuries • Rib fractures and flail chest: pain control, ventilation. • Pulmonary contusion: supportive care. • Tracheobronchial injury: bronchoscopy and repair. • Diaphragmatic rupture: surgical repair.

10. Complications • ARDS • Empyema • Pneumonia • Persistent air leak • Chronic pain / disability

11. Summary • Early recognition saves lives. • Apply ATLS principles. • Address life-threatening injuries first. • Use imaging wisely. • Multidisciplinary management essential.