Thoracic trauma

Self Explanatory.

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Thoracic Trauma

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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
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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
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Chest Anatomy
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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
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Tissue Hypoxia
Inadequate oxygen delivery
Hypovolemia
Ventilation/perfusion mismatch
Pleural pressure changes
Pump failure
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Thoracic Trauma
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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

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Primary Survey
“Deadly Dozen”
1.Airway obstruction
2.Open pneumothorax
3.Flail chest
4.Tension pneumothorax
5.Massive hemothorax
6.Cardiac tamponade
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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
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Primary “Deadly Dozen”
Airway obstruction
•Secondary hypoxia
Common cause of preventable death
Foreign body, tongue, aspiration
•Always assume cervical spine injury
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Open pneumothorax
•“Sucking chest wound”
Air enters pleural space
Ventilation impaired
Hypoxia results
•Signs and symptoms
Proportional to size of
defect
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Primary “Deadly Dozen”

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Open pneumothorax
•“Sucking chest wound”
Air enters pleural space
Ventilation impaired
Hypoxia results
•Signs and symptoms
Proportional to size of defect
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Primary “Deadly Dozen”

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Open pneumothorax
•Close chest wall defect
•Load-and-go
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Primary “Deadly Dozen”

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Flail chest
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Primary “Deadly Dozen”

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Flail chest
•Assist ventilation
•Load-and-go
•Stabilize flail segment
•Monitor for:
Pulmonary contusion
Hemothorax
Pneumothorax
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Primary “Deadly Dozen”

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Tension pneumothorax
•Dyspnea
•Anxiety
•Tachypnea
•Distended neck veins
•Tracheal deviation (rare)
•Breath sounds diminished
Hypertympany if percussed
•Shock with hypotension
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Primary “Deadly Dozen”

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Massive hemothorax
•Anxiety and confusion
•Neck veins
Flat: hypovolemia
Distended:
mediastinal compression
•Breath sounds decreased
Hypotympany if percussed
•Shock
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Primary “Deadly Dozen”

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Massive hemothorax
•Load-and-go
•Treat for shock
•Monitor for:
Hemopneumothorax
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Primary “Deadly Dozen”

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Cardiac tamponade
•Beck’s triad
Hypotension
Neck veins distended
Heart sounds muffled
•Paradoxical pulse
•Breath sounds equal
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Primary “Deadly Dozen”

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Cardiac tamponade
•Load-and-go
•Treat for shock
•Monitor
•Monitor for:
Hemothorax
Pneumothorax
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Primary “Deadly Dozen”

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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
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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)
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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
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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
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Secondary “Deadly Dozen”
Esophageal injury
•Penetrating trauma
•Difficult to assess in field
•If unrecognized, may be lethal
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Secondary “Deadly Dozen”
Pulmonary contusion
•Common from blunt trauma
•Hours to develop
•Marked hypoxemia
Impaled object
•Do not remove
•Gently stabilize object
•Avoid movement
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Other Chest Injuries
Traumatic asphyxia
•Severe compression
•Ruptures capillaries
Cyanosis above crush
Swelling of head, neck
Swollen tongue, lips
Conjunctival hemorrhage
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Other Chest Injuries
Simple pneumothorax
•Fractured ribs
•Pleuritic chest pain
•Dyspnea
•Decreased breath sounds
•Hypertympany if percussed
•Monitor for:
Tension pneumothorax
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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
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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
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Discussion
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