Chest trauma. 70 % deaths in road traffic accidents are due to thoracic trauma Traumas can be penetrating or blunt.
Post on 17-Dec-2015
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Hassan JamilFinal yearRoll no. 104Batch D
Chest trauma
Chest trauma
• 70 % deaths in road traffic accidents are due to thoracic trauma
• Traumas can be penetrating or blunt
Types
• Immediate life threatening injuries
• Potentially life threatening injuries
Immediate life threatening injuries
• Airway obstruction• Tension pneumothorax• Hemothorax• Cardiac temponade• Flial chest
Airway obstruction Any entity that causes disruption in the normal flow of air
Leads to• Hypoxia• Hypercapni
a
Management
• Mechanical removal of obstruction
• Endotracheal intubation
Tension Pneumothorax
• Air in the pleural space that is under high pressure
• One way valve injury• Due to lung parenchymal or
bronchial injury• External Trauma • Displaces mediastinal structures
Causes • Lung collapse• Hypoxia• Decreased venous return• Impaired cardiac function• Decreased cardiac output• Hypotension• Death
Life threatening condition
Physical examination
• Respiratory distress• Cyanosis• Decreased or absent lung
sounds• Hyperresonance on
percussion• Hypotension
Chest wall trauma
Trauma of the bronchial tree
Treatment
Thoracocentesis (insertion of a wide bore needle)
Followed by chest intubation
Point to remember
• Donot wait for x-ray to make diagnosis of tension pneumothorax
Hemothorax
• Presence of blood in the pleural space
• Caused due to trauma leading to injury of internal mammary or intercostal artery
Signs
• Reduced chest expansion• Dull percussion note• Absent breath sounds
Treatment
• Intercostal chest tube insertion attached to an underwater seal
• Thoracotomy in case of massive hemothorax
Cardiac tamponade
• Accumulation of blood in the pericardial sac
• Causes compression of the cardiac chamber
• Decreased cardiac filling, decreased cardiac output
• Patient presents with hypotension and distended neck veins
Treatment
• Pericardiocentesis• Thoracotomy
Flial chest
• Multiple rib fractures which produce a mobile fragment
• This fragment moves paradoxically with respiration
• Causes lung compression
Treatment
If the fragment is small and not interfering with respiration then patient is administered good analgesic until segment stabilizes
Potential life threatening injuries
• Tracheobronchial disruption• Aortic disruption• Diaphragmatic disruption• Pulmonary contusion
Tracheobronchial disruption
• Disruption at the junction of trachea and the main broncus
• In the region of the carnia• Causes collapsed lung and
massive air leak resulting in subcutaneous emphysema
Aortic disruption
• Caused due to deceleration injury
• Explain mechanism with diagram
• Tear in the aorta• Shock, deviation of the
visceras
Diaphragmatic disruption
• Trauma to the chest and abdomen causing tear in the diaphragm
• Diagnosis by chest radiograph showing stomach or colon in the chest
Pulmonary contusion
• Occurs in 30-75% of all the patients with major chest injury
• Caused by blunt trauma• Produces capillary disruption-intra
alveolar hemorrhage-edema-small airway obstruction
• Chest radiograph shows arterial blood gas analysis
• Treatment : fluid resuscitation, chest physiotherapy, analgesics
Other conditions• First rib fracture• Multiple rib fractures• Stove in chest• Cervical rib
Thankyou
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