Chest Trauma

Organs/Vessels
n

Thoracic cavity u Ribs u Diaphragm u Mediastinum (trachea, vena cava, aorta, esophagus, heart) u Lungs

Chest Anatomy

Pleura
n

n

2 Layers u Keep lungs expanded u Visceral layer u Parietal layer Pleural space u Small amount of fluid

Pericardial Cavity
Fibrous pericardium n Epicardium n Potential space - < 50 ml of fluid
n

Other Considerations
Liver and spleen located under lower ribs Trauma Below nipples – Assume abdominal injuries Trauma Above nipples – Assume cervical spine injury Always consider spinal column trauma GSW can damage both cavities Chest and abdominal trauma victims get high flow oxygen

Other Considerations
Major chest and abdominal trauma regularly occur together n When you see one, look for the other n I bet you will find it
n

Hypoxia Consideration (End Point)
n n n n n

Airway obstruction inadequate oxygendelivery Hypovolemia from blood loss Ventilation/perfusion mismatch from lung injury  Changes in pleural pressures  Pump failure

Manage hypoxia!!  Airway control  Rapid Transport

Trauma Injury Effects
n n n n n

Deadly Dozen
n n n n n n
Traumatic aortic rupture Airway obstruction Tracheal/bronchial tree Open pneumothorax Tension pneumothorax injury Myocardial contusion Massive hemothorax Flail chest Diaphragmatic tears Cardiac tamponade Esophageal injury Pulmonary contusion 

CLOSED CHEST INJURY
n

Closed (Blunt) – Falls, automobile crashes, direct blows to the chest u Force distributed over large area

OPEN CHEST INJURY
n

Open (Penetrating) – Knife, GSW, ice picks, broken glass, nails u Force distributed over a small area

Blunt Trauma

Penetrating Trauma

Pneumothorax
Blunt or penetrating trauma n Chest wall penetrated and air flows into the thoracic cavity around the lungs n Visceral and parietal pleura – air in pleural space collapses the lung n No penetration possible (broken rib), lung laceration - most common
n

Pneumothorax

Pneumothorax RX
Oxygen n Reassessment (tension pneumothorax possible) n Transport
n

Sucking Chest Wound
n n

n n

Penetrating trauma An open chest wound that sucks air into the wound; a noticeable sucking sound may be heard. u Additional air being sucked into cavity u Trapped air Cover with gloved hand, or occlusive dressing (tape 3 sides) Life Threat

Sucking Chest Wound

Tension Pneumothorax
Blunt or penetrating n When air builds up collapsing one or both lungs u Can compresses large vessels and heart
n

High flow oxygen n Reassessment n Rapid transport n Open sucking wound? Occlusive dressing – 3 sides taped
n

Rib Fractures
n n n n n n

Pain Most commonly blunt trauma Most commonly injured Reduced chest excursion – limits ventilation Consider pulmonary and/or myocardial contusions Consider pneumo/hemothorax

Rib Fractures S/S
Dyspnea n Shallow respirations n Guarding (self splinting) n Painful respirations n Tender, unstable ribs
n

Rib Fractures RX
Oxygen n Splint? n Reassessment n Transport
n

n n n n n n n

Major force involved Two or more adjacent ribs are broken in two or more places Unattached segment (flail segment) Paradoxical movement (opposite movement of the rest of the chest) Consider underlying injuries Stabilize with hand initially, splint later Life Threat

Flail Segment S/S
n n n n n n n

Tenderness, unstable segment Dyspnea Shallow respirations Guarding (self splinting) Painful respirations Paradoxical movement Shock

Flail Segment R/X
Provide high flow oxygen n Assist ventilations, if required n Stabilize flail segment (hand then bulky dressings) n Reassessment – Consider underlying injuries n Rapid Transport
n

Penetrating and blunt trauma n Rapid accumulation of blood in the chest (greater than 1500 ml) n Chest cavity can hold entire blood content
n

n n n n n n

Cyanosis Flat neck veins Respiratory distress Shock Cold clammy skin Breath sounds absent, hypo resonant

Hemothorax RX
High flow oxygen n Ventilate, as needed n Rapid assessment n Reassessment n Rapid Transport
n

Traumatic Asphyxia
Severe crush injury (blunt force) to the chest n Compression of the superior vena cava n Petechiae present n Cerebral edema n Head and neck swelling (tongue and lips) n Conjunctival hemorrhage
n

Traumatic Asphyxia S/S
n n n n

Swollen tongue, lips Bloodshot eyes Protruding eyes Chest trauma (blunt force)

Traumatic Asphyxia RX
CPR n CABC n High flow oxygen n Ventilate n Rapid transport
n

Pericardial Tamponade
Penetrating trauma common n Blood filling the pericardial sack n 15 ml – 20 ml of fluid removal may be life saving
n

Pericardial Tamponade S/S
n

n n n n

Beck’s Triad u Distended neck veins u Muffled heart sounds u Hypotension Tachycardia Narrowed pulse pressure Trachea midline Normal breath sounds

Pericardial Tamponade RX
High flow oxygen n Ventilate, as needed n Rapid transport n Reassessment
n

n n

Stabilize with dressings, build up around object Do not remove

Relevant Chest Trauma SAMPLE History
GSW u Caliber, distance, number of shots, angle n Stab Wounds u Length of blade, type of blade (smooth/serrated), sex of the stabber n Falls u Height, surface landed on, body part landed on
n

Assessment Techniques
Page 954 & 956

Inspection (observation) – DCAP BTLS n Palpation (touch) – Instability n Percussion (sound waves) – Striking an object and listening to the sound made n Auscultation (listening) – Stethoscope; breath sounds, heart tones
n

Palpation

Auscultation

Assessment Techniques
n

Vital signs u BP u Pulse u Respirations u Body Temperature

MOI Considerations
n

Page 217– “Scene Size- up” section u Automobile crash – steering wheel u Sports accident u Fall u GSW u Fight u Crush injury u Explosion

Pneumothorax (tension too) n Flail chest n Hemothorax n Sucking chest wound n Traumatic asphyxia n Pericardial tamponade
n

Terms
Asymmetrical chest wall movement that lessens respiratory efficiency

Terms

Terms
A dressing that can form an airtight seal over a wound

Terms
The difference between the systolic and diastolic blood pressures. Narrowing seen with pericardial tamponade.

Terms
Presence of air in the subcutaneous tissue; the resulting crackling sensation or sound

Tension Pneumothorax
page 945

Build up of air and pressure in the thoracic cavity of the injured lung is so severe that it places pressure on the uninjured lung. n Results in compression of the heart, large vessels, and the uninjured lung.
n n

BAD STUFF

BAD STUFF

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