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Chest Trauma: Types, Diagnosis, and Treatment

The document discusses various types of chest trauma including pneumothorax, pleural effusion, lung abscess, and foreign bodies. It covers the etiology, clinical features, investigations, complications and treatment options for each condition. Pneumothorax can be closed, open or tension pneumothorax. Pleural effusions are exudative or transudative based on fluid analysis. Lung abscesses are usually caused by aspiration or infection and may require drainage or antibiotics. Foreign bodies in the airway or esophagus require careful history and imaging to guide removal.

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144 views37 pages

Chest Trauma: Types, Diagnosis, and Treatment

The document discusses various types of chest trauma including pneumothorax, pleural effusion, lung abscess, and foreign bodies. It covers the etiology, clinical features, investigations, complications and treatment options for each condition. Pneumothorax can be closed, open or tension pneumothorax. Pleural effusions are exudative or transudative based on fluid analysis. Lung abscesses are usually caused by aspiration or infection and may require drainage or antibiotics. Foreign bodies in the airway or esophagus require careful history and imaging to guide removal.

Uploaded by

Amna
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

CHEST TRAUMA

PROF. ANJUM SOHAIL ANSARI


H.O.D SURGERY
CIMS, BAHAWALPUR
 Injuries to :

 LUNG & PLEURA

 NEUROVASCULAR

 PRECORDIUM

 MUSCLES

 FOREIGN BODIES
PNEUMOTHORAX
TYPES

 Closed Pneumothorax
 Open Pneumothorax
 Tension Pneumothorax
ETIOLOGY
 Spontaneous
Primary --- smoker
Secondary -- emphysema, CF,lung CA,COPD

 Iatrogenic
CVC, TT/TB lung biopsy, pacemaker, pl tap,
PPV

 Traumatic
CLINICAL FEATURES

 DYSPNEA
 Chest pain
 Inspection
 Palpation
 Percussion
 Auscultation

 Engorged neck veins…..tension


INVESTIGATION

 CXR expiration
 CT Chest
 ABG
D/D

 Musculoskeletal
 PE
 Empyema
 MI
 Infection pneumonia
TREATMENT

Options are
 Observation
 Aspiration
 Percutaneous catheters
 Tube thoracostomy
 Bedside Pleurodesis (Doxycycline, talc)
 Iatrogenic
Observation
Chest tube
 Spontaneous
Pleurodesis
Surgery
Wedge resection + Pl.Abraison
-VATS
-Thoracotomy
 Small <15%
Observation
 Medium 15-50% and Large >50%
Stable pt
Unstable pt
 Traumatic (Tension/ open pneumothorax
Flail Chest, lung Contusion)
Chest tube
PCA
ABG’s
ETT /Tracheostomy & IPPV
Surgery (hemothorax, bronchopleural
fistula)
Underwater seal
PLEURAL EFFUSION
Starling’s law

 J = Kf [(Pv-Pi)- (v-i) ]
TYPES
EXUDATIVE TRANSUDATIVE

>200 or
Fluid LDH (IU/dL) >2/3 upper normal <200
serum

Fluid/Serum LDH ratio >0.6 <0.6

Protein(g/dl) >3 <3

Fluid/Serum protein
> 0.5 <0.5
ratio

Specific gravity 1.016 <1.016


ETIOLOGY
 TRANSUDATIVE
CCF
Constrictive pericarditis
Cirrhosis
Nephrotic Syndrome
Myxedema
Meig’s Syndrome
SVC Obstruction
 EXUDATIVE
Malignant
Lymphoma , CA bronchus
Benign
Infection
Inflammation
Chylous
CLINICAL FEATURES

 Shortness of breath
 Dry Cough
 Pleuritic Pain
 Fever
 Mediastinal Shift
 Bulging
 Dec Movements VF, VR
 Stony Dull
 Absent Breath Sounds
INVESTIGATION

 CXR (AP 250 ml/ Decubitas*)


Mild, Moderate, Severe
 CT chest
 USG
 Thoracentesis
Glucose, pH, Protein, LDH, Amylase,
RBC’s , WBC’s, Malignant cells
Gram Stain, Culture
TREATMENT
 Transudative
Rx the cause
Aspiration
 Exudative
Malignant – Drainage
- Pleurodesis
Benign- as empyema
LUNG ABCESS
DEFINITION

 Localized collection of pus in a larger cavity


lined by chronic inflammatory tissue
ETIOLOGY

 Aspiration Pneumonia
 Suppurative Pneumonia
 S. Aureus, Klebsiella, Pseudomonas
 Transdiaphragmatic
 Amebic Liver Abscess
 Bronchial obstruction
 Infected infarct
 Lung cysts/bullae
CLINICAL FEATURES

 Fever + rigors/sweating
 Productive Cough + hemoptysis
 Pleuritic chest pain

 Weight loss
 Clubbing
 Pleural rub
INVESTIGATIONS

 CXR
homogenous lobar or segmental opacity
surrounded by consolidation
 USG
 Sputum Examination
 CBC
 Bronchoscopy
COMPLICATIONS

 Bronchiectasis
 Residual fibrosis
 Empyema
 BPF
 Cerebral abscess
TREATMENT

 Antibiotics
 Drainage
 Chest tube
 Postural
FOREIGN BODIES
Material Ingested

 Child
 Adults
 Old
 RSA
CLINICAL FEATURES
 History of ingestion/ inhalation
 LARYNX
pain, dysphagia, cough,stridor
para & retropharyngeal abcess
Salivary pool in pyriform fossa
erythema,edema
INVESTIGATION

 X-rays…..Normal
 Gastrograffin Swallow
 CT scan
TREATMENT
 FIRST AID
 Infant….hooking, inverting & slapping
 Children..bend them on your knees
 Adult… Heimlich manoeuvre
 SECURE AIRWAY
 Cricothyroidotomy
 Tracheostomy
 ENDOSCOPY (EUA)

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