Prehospital Trauma Life Support

Lesson

5

Thoracic Trauma

PROVIDER COURSE
Copyright © 2003, Elsevier Science (USA). All rights reserved.

Objectives
• Review the anatomy of the chest • Discuss the mechanics of breathing • Detail the assessment process • Cover the management of:
– – – – – Rib fracture Flail chest injury Pulmonary contusion Pneumothorax (open and tension) – Hemothorax – Blunt cardiac injury

5-2
Copyright © 2003, Elsevier Science (USA). All rights reserved.

• Thoracic injuries are a leading cause of trauma deaths each year • Thoracic injuries often go unrecognized • Injuries may result in inadequate ventilation. hypoxia. All rights reserved. Elsevier Science (USA). and shock • Our goal is to find these injuries early and treat them aggressively 5-3 Copyright © 2003. hypercarbia. .

Anatomy Identify these structures in the thorax: Trachea Aorta Bronchi Heart Esophagus Vena cava Lobes of the lungs 5-4 Copyright © 2003. All rights reserved. Elsevier Science (USA). .

. Elsevier Science (USA).Physiology What happens during inspiration? What happens during expiration? 5-5 Copyright © 2003. All rights reserved.

Gas Exchange in the Lungs Connective tissue Capillary endothelium CO2 O2 O2 Alveolar epithelium How does thoracic trauma interfere with gas exchange in the lung? Alveolus 5-6 Copyright © 2003. . All rights reserved. Elsevier Science (USA).

Neurochemical Control How does the CO2 level in the blood affect VR? Can thoracic trauma alter the blood level of CO2? 5-7 Copyright © 2003. . Elsevier Science (USA). All rights reserved.

Assessment • Kinematics will give important clues to the presence of thoracic trauma • Most significant chest injuries will be identified in the primary survey 5-8 Copyright © 2003. Elsevier Science (USA). . All rights reserved.

Assessment • Observation – What are we looking for? • Auscultation – What are we listening for in the chest? • Palpation – Why are we feeling the chest? 5-9 Copyright © 2003. Elsevier Science (USA). . All rights reserved.

Elsevier Science (USA). .Thoracic Trauma • Mechanisms of injury causing thoracic trauma fall into two categories: – Blunt – Penetrating Can you give some examples for each? 5-10 Copyright © 2003. All rights reserved.

What injuries could occur with this mechanism? 5-11 Copyright © 2003. you encounter a 19-year-old male complaining of chest pain and dyspnea. All rights reserved. . Elsevier Science (USA).Responding to a call at a police station. You learn that your patient was kicked in the chest during a fight.

Primary Survey A . All rights reserved. . VR fast C . normal pulse rate D .No external bleeding.Patent B . Elsevier Science (USA).Left chest pain during inspiration.GCS score 15 What injuries can you rule out? How should this patient be managed? 5-12 Copyright © 2003. BS equal.

All rights reserved. Elsevier Science (USA). You find him lying on the gravel in obvious ventilatory distress. He admits to having “one beer. .A 35-year-old motorcycle rider lost control of his bike. The scene is safe.” 5-13 Copyright © 2003.

Paradoxical motion of the right chest. .Primary Survey A . V-4.Patent B . All rights reserved. VR rapid C . radial pulse fast D .GCS score 14 (E-4.No external bleeding. diminished BS on right side. Elsevier Science (USA). M-6) What injuries do you suspect? How would you manage this patient? 5-14 Copyright © 2003.

Elsevier Science (USA). . Police inform you that the weapon was a .You respond to a call and find a 16-year-old male who has been shot in the right upper chest. What do you know about . All rights reserved.22-caliber bullets? 5-15 Copyright © 2003.22-caliber handgun.

Primary Survey A .No external bleeding. no exit wound noted. All rights reserved.Patent B . air not bubbling through wound C . Elsevier Science (USA). .GCS score 15 What injuries do you suspect? How would you manage this patient? 5-16 Copyright © 2003.VR fast. BS diminished on right. fast pulse rate D .

You respond to a call at a construction site where a 45-year-old male has fallen 25 ft (8 m) from a scaffolding and landed on a stack of lumber. . All rights reserved. 5-17 Copyright © 2003. On your arrival you find the patient complaining of chest pain and dyspnea. Elsevier Science (USA).

All rights reserved. no radial pulse palpable D .VR rapid and shallow.No external bleeding. Elsevier Science (USA). . weak carotid pulse.Patent B .Primary Survey A . rapid. no obvious JVD C .GCS score 15 What is the most life-threatening problem? What are your treatment priorities? 5-18 Copyright © 2003. speaks in 2 to 3 word bursts. BS absent on left.

.Simple Pneumothorax • Mechanism of injury • Ventilation – Decreased or absent BS – Mild respiratory distress • Treatment – Oxygen – Monitor – Rapid transport 5-19 Copyright © 2003. All rights reserved. Elsevier Science (USA).

Tension Pneumothorax • Mechanism of injury • Ventilation – Decreased or absent BS – Mild respiratory distress • Hemodynamic compromise • Treatment – Oxygen – Needle decompression – Rapid transport 5-20 Copyright © 2003. Elsevier Science (USA). All rights reserved. .

An intoxicated 50-year-old male is found with a self-inflicted injury to his left chest. . 5-21 Copyright © 2003. Elsevier Science (USA). A steak knife is impaled in the left third intercostal space on the midclavicular line. All rights reserved.

Patent B . normal BS bilaterally C . fast pulse rate. muffled heart tones D . . no palpable radial pulse.GCS score 14 (E-4.JVD noted What do these findings suggest? What is your management? 5-22 Copyright © 2003.Primary Survey A . All rights reserved.VR rapid. V-4.No external bleeding. Elsevier Science (USA). M-6) E .

The patient has been extricated on your arrival. .Your patient is a 60-year-old female who was involved in a head-on MVC. Elsevier Science (USA). Looking at the vehicle. The steering wheel is bent and the patient denies using her seat belt. you surmise that this was a highenergy impact. All rights reserved. 5-23 Copyright © 2003.

VR normal. BS clear. bruising over sternum C .No external bleeding.GCS score 15 What injuries do you suspect? 5-24 Copyright © 2003. All rights reserved.Primary Survey A .Patent B . normal pulse rate D . irregular pulse. . Elsevier Science (USA).

. All rights reserved. Elsevier Science (USA).Blunt Cardiac Injury • Blunt cardiac injury can result in: – Contusion with possible electrical conduction disturbance – Acute valvular injury – Rupture of the myocardial wall 5-25 Copyright © 2003.

All rights reserved. Elsevier Science (USA). .Blunt Cardiac Injury • Dysrhythmias are the most common manifestation • May mimic a myocardial infarction • Shock rarely seen How is this problem managed? 5-26 Copyright © 2003.

All rights reserved. .Summary • The thoracic cavity contains the vital organs that oxygenate and distribute blood to the rest of the body • Only a few key interventions can be performed in the field • Early recognition and management of thoracic injuries should result in improved patient outcomes 5-27 Copyright © 2003. Elsevier Science (USA).

Please make a selection from the menu below. Elsevier Science (USA).Prehospital Trauma Life Support Lesson Five is complete. . All rights reserved. Return to Main Menu Return to Provider Course Table of Contents Exit/Quit 5-28 Copyright © 2003.

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