Chest_Trauma_EMT_Presentation.pptt helpful

RTA case scenario

1. Case Presentation: Chest Trauma (EMT Assignment) By Showket Ali

2. Scenario / Patient Summary 35-year-old male, restrained driver, motor vehicle accident (15 min ago). Key points: - Seatbelt injury → rib fractures, pulmonary contusion. - Golden Hour: first 60 minutes critical. Assessment: - Scene safety, mechanism of injury. - Look for seatbelt marks, steering wheel imprint, windshield damage. Q: What’s the importance of the Golden Hour? A: Improves survival, reduces complications.

3. Primary Complaints Severe chest pain, shortness of breath. Possible causes: - Rib fracture - Pneumothorax - Hemothorax - Cardiac contusion Assessment: - Chest palpation (tenderness/crepitus). - Inspect symmetry, auscultate lungs, check SpO₂. Q: Which injury is immediately life-threatening? A: Tension pneumothorax.

4. Vital Signs HR: 120, BP: 100/60, RR: 28, SpO₂: 80%, GCS: 15. Interpretation: Respiratory compromise + early shock. Assessment: - Monitor SpO₂ and HR continuously. - Check BP trends. - Look for JVD, tracheal deviation. Q: Which vital sign is most worrying? A: SpO₂ = 80% (life-threatening hypoxemia).

5. Physical Examination Findings: Bruising left chest, subcutaneous emphysema. Implication: Likely rib fracture + pneumothorax. Assessment: - Palpate for crepitus. - Auscultate for absent breath sounds. Q: What does crepitus under skin suggest? A: Pneumothorax or airway rupture.

6. Differential Diagnoses 1. Blunt chest trauma 2. Rib fractures 3. Pneumothorax / Tension pneumothorax 4. Hemothorax Most dangerous: Tension pneumothorax (causes obstructive shock). Assessment: - Rib fracture → palpation. - Pneumothorax → hyperresonance, absent sounds. - Hemothorax → dullness, hypotension. Q: Why is tension pneumothorax more dangerous? A: It compresses heart/great veins → obstructive shock.

7. Management - Rib fracture: O₂, IV access, pain relief. - Simple pneumothorax: O₂, monitor. - Tension pneumothorax: Needle decompression. - Hemothorax: O₂, IV fluids, chest tube (hospital). Assessment: Recheck SpO₂, HR, RR. Q: First step if tension pneumothorax suspected? A: Immediate needle decompression.

8. ABCDE in Trauma A: Airway (control, cervical spine). B: Breathing (O₂, auscultate, needle decompression). C: Circulation (IV fluids, BP/HR). D: Disability (GCS, pupils). E: Exposure (fully expose, prevent hypothermia). Assessment: - Airway: stridor/gurgling. - Breathing: symmetry, auscultation. - Circulation: pulse, skin color. Q: Why not jump to C before B? A: Without breathing, circulation is useless.

9. Needle Decompression Sites: 2nd ICS (MCL) or 5th ICS (AAL). Steps: 1. Identify site 2. Prep with antiseptic 3. Insert 14–16G needle above rib 4. Rush of air confirms 5. Leave cannula, transport Assessment: Immediate improvement in SpO₂, HR. Q: Preferred site? A: 5th ICS AAL (safer, fewer complications).

10. ECG in Blunt Trauma Role: Detect cardiac injury (contusion, MI, tamponade). Look for: - ST elevation/depression - Arrhythmias (VT, VF) - Conduction blocks - Low voltage / electrical alternans (tamponade) Assessment: Serial ECGs, continuous monitoring. Q: ECG finding of tamponade? A: Electrical alternans.