Transcript Chest Trauma

Chest Trauma
Dr. Khayal Al Khayal
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

Mechanism of Injury
Penetrating injuries
E.g. stab wounds etc.
 Primarily peripheral lung
 Haemothorax
 Pneumothorax
 Cardiac, great vessel or oesophageal
injury

Blunt injuries
Either:
- direct blow (e.g. rib fracture)
- deceleration injury or
- compression injury
 Rib fracture is the most common sign of
blunt thoracic trauma
 Fracture of scapula, sternum, or first rib
suggests massive force of injury

Chest wall injuries

Rib fractures

Flail chest

Open pneumothorax
Rib fractures
Most common thoracic injury
 Localised pain, tenderness, crepitus
 CXR to exclude other injuries
 Analgesia..avoid taping
 Underestimation of effect
 Upper ribs, clavicle or scapula fracture:
suspect vascular injury

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
Tension pneumothorax
Air enters pleural space and cannot
escape
 P/C: chest pain, dyspnoea
 Dx: - respiratory distress
- tracheal deviation (away)
- absence of breath sounds
- distended neck veins
- hypotension


Surgical emergency

Rx: emergency decompression before
CXR

Either large bore cannula in 2nd ICS,
MCL or insert chest tube

CXR to confirm site of insertion
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

Heart, Aorta & Diaphragm
Blunt cardiac injury
- contusion
- ventricular, septal or valvular
rupture
 Cardiac tamponade
 Ruptured thoracic aorta
 Diaphragmatic rupture

Cardiac Tamponade
Blood in the pericardial sac
 Most frequently penetrating injuries
 Shock, JVP, PEA, pulsus paradoxus
 Classically, Beck’s triad:
- distended neck veins
- muffled heart sounds
- hypotension
 Rx: Volume resuscitation
Pericardiocentesis

Cardiac tamponade
Aortic rupture
Usually blunt trauma involving
deceleration forces; especially RTAs
 ~90% die within minutes
 Most common site near ligamentum
arteriosum
 Dx: clinical suspicion, CXR, aortography,
contrast CT or TOE
 Rx: surgical…poor prognosis

Aortic rupture
Iatrogenic trauma
-coiling
-endobronchial placement
-pneumothorax
 Chest tubes: - subcutaneous
- intraparenchymal
- intrafissural
 Central lines: - neck
- coronary sinus
- pneumothorax

NG tubes:
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
