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Chest Trauma

Introduction
Chest trauma is often sudden and dramatic  Accounts for 25% of all trauma deaths  2/3 of deaths occur after reaching hospital  Serious pathological consequnces: -hypoxia, hypovolaemia, myocardial failure

g. great vessel or oesophageal injury  . stab wounds etc.  Primarily peripheral lung  Haemothorax  Pneumothorax  Cardiac.Mechanism of Injury Penetrating injuries E.

compression injury  Rib fracture is the most common sign of blunt thoracic trauma  Fracture of scapula. rib fracture) .g. sternum.Blunt injuries Either: .direct blow (e.deceleration injury or . or first rib suggests massive force of injury  .

Chest wall injuries Rib fractures    Flail chest Open pneumothorax .

crepitus  CXR to exclude other injuries  Analgesia.avoid taping  Underestimation of effect  Upper ribs.Rib fractures Most common thoracic injury  Localised pain. clavicle or scapula fracture: suspect vascular injury  .. tenderness.

Flail chest Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration  Significant force required  Usually diagnosed clinically  Rx: ABC Analgesia  .

Flail chest .

Flail Chest .detail .

Open pneumothorax Defect in chest wall provides a direct communication between the pleural space and the environment  Lung collapse and paroxysmal shifting of mediastinum with each respiratory effort ± tension pneumothorax  “Sucking chest wound”  Rx: ABCs…closure of wound…chest drain  .

Lung injury Pulmonary contusion  Pneumothorax  Haemothorax  Parenchymal injury  Trachea and bronchial injuries  Pneumomediastinum  .

Pneumothorax Air in the pleural cavity  Blunt or penetrating injury that disrupts the parietal or visceral pleura  Unilateral signs: movement and breath sounds. resonant to percussion  Confirmed by CXR  Rx: chest drain  .

Pneumothorax .

tracheal deviation (away) . dyspnoea  Dx: .absence of breath sounds .distended neck veins .hypotension  .respiratory distress .Tension pneumothorax Air enters pleural space and cannot escape  P/C: chest pain.

MCL or insert chest tube CXR to confirm site of insertion  .  Surgical emergency Rx: emergency decompression before CXR  Either large bore cannula in 2nd ICS.

Haemothorax Blunt or penetrating trauma  Requires rapid decompression and fluid resuscitation  May require surgical intervention  Clinically: hypovolaemia absence of breath sounds dullness to percussion  CXR may be confused with collapse  .

Aorta & Diaphragm Blunt cardiac injury .ventricular.Heart. septal or valvular rupture  Cardiac tamponade  Ruptured thoracic aorta  Diaphragmatic rupture  .contusion .

pulsus paradoxus  Classically. Beck’s triad: . JVP.Cardiac Tamponade Blood in the pericardial sac  Most frequently penetrating injuries  Shock.muffled heart sounds . PEA.distended neck veins .hypotension  Rx: Volume resuscitation Pericardiocentesis  .

Cardiac tamponade .

aortography. CXR. especially RTAs  ~90% die within minutes  Most common site near ligamentum arteriosum  Dx: clinical suspicion. contrast CT or TOE  Rx: surgical…poor prognosis  .Aortic rupture Usually blunt trauma involving deceleration forces.

Aortic rupture .

intrafissural  Central lines: .Iatrogenic trauma -coiling -endobronchial placement -pneumothorax  Chest tubes: .subcutaneous .intraparenchymal .coronary sinus .pneumothorax  NG tubes: .neck .

Line in jugular vein .

Misplaced nasogastric tube .

Chest trauma: summary Common  Serious  Primary goal is to provide oxygen to vital organs  Remember Airway Breathing Circulation  Be alert to change in clinical condition  .

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