60pleural effusion Lecture No. 08.pptx - CHEST TRAUMA...

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CHEST TRAUMA
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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 consequences: - hypoxia, hypovolemia, myocardial failure
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Mechanism of Injury Penetrating injuries e.g. stab wounds etc. Primarily peripheral lung Haemothorax Pneumothorax Cardiac, great vessel or oesophageal injury
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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 Blunt injuries
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Deadly Dozen from ATLS Airway obstruction Open Pneumo Flail Chest Tension Pneumo Massive Hemothorax Cardiac Tamponade Detected in the primary survey
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Deadly Dozen from ATLS Myocardial contusion Traumatic aortic rupture Tracheal bronchial tear Diagphragmatic injury Esophageal injury Pulmonary contusion Detected in the secondary survey
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Chest wall injuries Rib fractures Flail chest Open pneumothorax
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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
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Flail chest Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration 2 or more ribs in 2 or more places Significant force required Palpate carefully and laterally Rx: ABC s and analgesia +/- splint the flail segment
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Flail chest
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Flail Chest - detail
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PLEURAL EFFUSION, PYOTHORAX & PNEUMOTHORAX
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Pleural cavity
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Pleural space
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DEFINITION Pleural effusion: inflammation of the pleura, accompanied by collection of fluid in the pleural space. Normal Pleural fluid: 0.3 ml/kg BW Protein: 1.5 g/dL pH: alkaline (7.60) Cells: 1700 cells/ml (75% macrophages, 23% lymphocytes & 2% mesothelial cells)
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Inflammation of pleura Pleuritis sicca Cause: viral infection Symptoms: Pleuritic chest pain Pleural friction rub Therapy: Symptomatic
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Pleural space should be virtually fluid free Pleural fluid is produced by the parietal pleura and absorbed by the visceral pleura as a continuous process
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Fluid accumulates in the pleural space by three mechanisms: increased drainage of fluid into the space increased production of fluid by cells in the space decreased drainage of fluid from the space
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Development of Pleural Effusion pulmonary capillary pressure (CHF) capillary permeability (Pneumonia) intrapleural pressure (atelectasis) plasma oncotic pressure (hypoalbuminemia) pleural membrane permeability (malignancy) lymphatic obstruction (malignancy) diaphragmatic defect (hepatic hydrothorax) thoracic duct rupture (chylothorax)
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CAUSES EXUDATIVE (usually unilateral) Parapneumonic effusion Tuberculosis Connective tissue disorders Malignancy Pancreatitis Subphrenic abscess Severe dengue Radiation pleuritis TRANSUDATIVE (usually bilateral ) Congestive heart failure Cirrhosis Nephrotic syndrome
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  • Fall '19
  • Pneumothorax, Flail Chest, Pleural effusion

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