TRAUMA THORAKS

Supervisor: dr. Marshal, SpB, SpBTKV(K)

Andrian 150100036
Achmad Syukran Fauzan 150100065
Alicia 150100103
Alfredo Fransiscus 150100164
Putri Wulandari 150100188
Ian Rimhot Sinaga 120100249
 INTRODUCTION

- Thoracic trauma causes about 25% of traumatic

deaths.

- Can be prevented if diagnosed and treated

properly

- Thoracic trauma is broadly catagorized into blunt

and penetrating, blunt chest trauma is more
common than penetrating trauma.
ANATOMY OF THORAX
MECHANISM OF TRAUMA

Blunt trauma
Deceleration Trauma
Compression Trauma

Penetrating trauma
High velocity  gun shot
Low velocity  Knife, sharp object
Blunt trauma Penetrating trauma
The most important thoracic
trauma include the
followings:
Aortic disruption

Blunt cardiac injury

Cardiac tamponade

Flail chest

Hemathorax

Pneumothorax

- Tension pneumothorax

- Open pneumothorax

- Traumatic pneumothorax

Pulmonary contusion

Rib fracture
 AORTIC
DISRUPTION
The aorta can rupture completely or incompletely after blunt or
penetrating trauma.

Sign may include:

- asymmetric pulses or BP

- decreased blood flow to the lower extremities

- precordial systolic murmur

Diagnosis is often suspected because of the mechanism of

injury and/or chest x-ray findings and confirmed by CT,
ultrasonography, or aortography.

Treatment is open repair or stent placement.

AORTIC DISRUPTION
Blunt cardiac injury
(cardiac contusion)
Blunt cardiac injury is blunt chest trauma
that causes:

- contusion of myocardial muscle

- rupture of a cardiac chamber

- disruption of a heart valve

Sometimes a blow to the anterior chest

wall causes cardiac arrest without any
structural lession.
 Blunt cardiac injury
(cardiac contusion)
Injury manifestations
Mycardial contusion may be Asymptomatic
tachycardia (+/-)
Conduction abnormalities(+/-)
arrhytmias(+/-)
Ventricular rupture Usually rapidly fatal
Right sided lession present with
cardiac tamponade (due to atrial
rupture)

Septal rupture May not cause symptoms initially,

but may present later with heart
failure
 Blunt cardiac injury
(cardiac contusion)
Valve disruption Causing heart murmur
Sometimes
manifestattions of heart
failure (dyspnoe,
pulmonary crackles,
sometimes hypotension)
Commotio cordis Sudden cardiac arrest that
follows a blow to the anterior
chest wall in patients who do
not have pre-existing or
traumatic structural heart
disease.
 Blunt cardiac
injury
(cardiac contusion)
Diagnosis:
- ECG

- Echocardiography

- cardiac enzymes

Treatment: supportive care

patients with myocardial contusion causing conduction

abnormalities require cardiac monitoringfor 24 h because
they are at risk for sudden arrhytmias

Surgical repair is indicated for rare cases of myocardial or

valcular rupture
 Blunt cardiac
injury
(cardiac contusion)
 Cardiac Tamponade
Accumulation of blood in the pericardial sac of
sufficient volume and pressure to impair cardiac
filling.

More common on penetrating trauma than blunt

trauma

Diagnosis is made clinically and often with bedside

echocardiography.

Treatment is immediate pericardiocentesis or

pericardiotomy
 Cardiac Tamponade
Beck’s Triad:
Increased JVP
Lowered heart sound
Persistent hypotension
Cardiac Tamponade
Cardiac Tamponade
 Flail Chest
Flail chest is multiple fractures in ≥3 adjacent ribs
that result in a segment of the chest wall seperating
from the rest of the thoracic cage

Lowered ventilation can cause hypoxia and

hypercarbia
Flail Chest
Flail Chest
 Flail Chest

Treatment:
• ATLS
• Analgetic
• PEEP Mechanical
ventilator and PEEP if
needed
 Stabilisation of chest wall
with internal fixation
 Haemothorax
Haemothorax is accumulation of blood in the
pleural space

The usual cause of hemothorax is laceration

of the lung, intercostal vessel, or an internal
mammary artery.

It can result from penetrating or blunt

trauma.

Hemothorax is often accompanied by 

pneumothorax (hemopneumothorax).
 Massive hemothorax

Massive hemothorax is most often defined

as rapid accumulation of ≥ 1000 mL of
blood. Shock is common.

Patients with large hemorrhage volume

are often dyspneic and have decreased
breath sounds and dullness to percussion.
Massive hemothorax
 Massive hemothorax
Treatment:

ATLS

Chest tube insertion (WSD)

Thoracotomy indication if blood came out :

> 1500 cc in an hour after trauma
5 cc/kgBW/hour
3-5 cc/kgBW for 3 hours contionusly
 Tension Pneumothorax
 Tension pneumothorax is accumulation of air in the
pleural space under pressure, compressing the lungs
and decreasing venous return to the heart.
 Causes include mechanical ventilation (most
commonly) and simple pneumothorax with lung
injury that fails to seal following penetrating of blunt
chest trauma or failes central venous cannulation.
Tension Pneumothorax
 Tension Pneumothorax
Treatment:

ATLS

Needle thoracostomy  Large size venocath (14 G)

inserted on the rib 2 gap midclavicular

Chest tube insertion (WSD)

Treatment MUST BE immediate due to life

threatening condition
 Open Pneumothorax

Open pneumothorax is a pneumothorax involving an

unsealing opening in the chest wall

Found open wound on the chest, diameter > 2/3

trachea “sucking chest wound”

Found tachypnoea, tachycardia, difficulty of

breathing, weakened to disappeard breath sound
 Open Pneumothorax

Pneumotoraks terbuka Plester 3 sisi

Open Pneumothorax
 Open Pneumothorax
Treatment:
 ATLS
 Close the wound with three sided plaster
 Intensive monitoring to the possibility of tension
pneumothorax
 Chest tube insertion (WSD) with creating new wound
suture the old wound
 If there is massive leakage and persist  Thoracotomy
 Traumatic Pneumothorax

Traumatic pneumothorax is air in the pleural space

resulting from trauma and causing partial or
complete lung collapse.

Symptoms include chest pain from the causative

injury and sometimes dypsnea.

Diagnosis is made by chest x-ray.

Treatment is usually with tube thoracostomy.

Pulmonary contusion
Pulmonary contusion is trauma- induced
lung hemorrhage and edema without
laceration.

Patients may have associated rib fracture,

pneumothorax, or other chest injury.

Larger contusion can impair oxygenation.

Late complications include pneumonia and

sometimes acute respiratory distress
symptoms (ARDS).

Symptoms include pain, sometimes

dyspnoe.
Pulmonary
contusion
 RIB FRACTURE
Typically, rib fractures result from blunt injury to the
chest wall, usually involving a strong force (eg, due to
high-speed deceleration, a baseball bat, a major fall);
however, sometimes in the elderly, only mild or
moderate force (eg, in a minor fall) is required.

If ≥ 3 adjacent ribs fracture in 2 separate places, the

broken segment results in a flail chest.

Symptoms: pain is severe, is aggravated by movement

of the trunk (including coughing or deep breathing),
and lasts for several weeks. The affected ribs are quite
tender; sometimes the clinician can detect crepitance
over the affected rib as the fracture segment moves
during palpation.
RIB FRACTURE
 RIB FRACTURE
Treatment:
• ATLS
• Analgetic
 Stabilisation of chest wall with internal
fixation
THANKYOU