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Chest Trauma
Objectives
1. Review the anatomy of the chest.
2. Discuss the mechanics of breathing.
3. Detail the assessment process.
4. Cover the management of blunt and penetrating chest injuries.
• Chest injuries are the second leading cause of
trauma deaths each year.
• Chest injuries often go unrecognized.
• Missed injuries result in inadequate ventilation,
hypoxia and hypercarbia.
• Our goal is to find these injuries early and treat
them aggressively.
Introduction
Anatomy
&
Physiology
Anatomy
• Major structures in the thorax:
– Trachea.
– Bronchi.
– Lobes of the lungs.
– Heart.
– Aorta.
– Vena cava
– Esophagus.
V.A.N.
Anatomy & Physiology
Physiology
During inhalation and exhalation, the diaphragm moves
allowing for the lungs to expand/contract
Chest Trauma
Mechanism of injury:
1. Penetrating.
2. Blunt
3. Blast
Evaluation
• General signs:
Mechanism of Injury / Scene-Story
Fracture / Bruise / Wound
Asymetric Movement
Bloody foam from mouth and / or wound
Respiratory distress
Evaluation
• Respiratory distress:
Dyspnea
Pleuritic Pain
General distress
Tachypnea
Cyanosis
Retraction on Intra-costal muscles
Fractured Rib
• One rib fracture -
• Main danger: Difficulty breathing due to pain. Emphasis:
• Ribs # 1,2- Severe trauma
• Ribs # 9-12- Suspect internal organ injury
• Treatment: Analgesics, evacuation + high dose O2
Multiple Rib Fractures • Multiple rib fracture
• Flail chest
Dislocated section from rib cage
Paradoxical breathing
Severe pain and notable breathing difficulty
Lung Contusion
Flail Chest
Treatment:
Positive pressure ventilations
High dose O2
Evacuation
Chest Injuries
Pneumothorax
Open Closed
Simple
Pneumothorax
Tension
Chest Injuries
Hemothorax
Open Sucking
Chest Wound
• Open: a penetrating injury that allows air
to go in and out - the pressure between the pleura membranes is damaged.
• Closed: accumulation of air in the chest
closed: open:
Pneumothoraxes
Signs and Symptoms
Open Pneumothorax
Open chest wound
Mechanism of injury
General signs of chest injury
Respiratory Distress
Decreased breath sounds
Open Pneumothorax
Treatment:
Seal wound/s*
(Asherman)
Oxygen
Artificial ventilation*
Monitor
Evacuation
Major danger of Open Sucking Chest Wound?
Tension Pneumothorax
Chest Injury
Tension Pneumothorax
• What’s wrong with this X-ray?
Tension Pneumothorax Specific signs & symptoms:
Extreme respiratory distress
Shock
Jugular Vein Distention
Tracheal Deviation (late sign)
Absent breath sounds on the affected
side
Hypotension
Subcutaneous empysema
Hemothorax
Dangers: Hypovolemic
Shock Respiratory failure
Treatment:
IV Fluids
Oxygen
Rapid evacuation
A build up of blood in the pleural cavity
Treatment for
Chest Trauma
Treatment - continued
S.S.S Evaluate Kinetic energy
A
B Expose chest
Evaluate breathing quality
Ventilate if needed
Seal wound
Oxygen
Do not seal
wound if
ventilation
is required
Treatment - continued C
Hemodynamic – evaluation
D
E Search for additional wounds, seal off
Scoop & Run
En Route
Vital signs Monitor victim’s breathing status
Oxygen If not enough- begin ventilations
IV fluids
If situation deteriorates, or before ventilations
Remove AIR SEAL!!!