60pleural effusion Lecture No. 08.pptx - CHEST TRAUMA Introduction Chest trauma is often sudden and dramatic Accounts for 25 of all trauma deaths 2\/3 of

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 consequences: - hypoxia, hypovolemia, myocardial failure

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

 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

Deadly Dozen from ATLS  Airway obstruction  Open Pneumo  Flail Chest  Tension Pneumo  Massive Hemothorax  Cardiac Tamponade Detected in the primary survey

Deadly Dozen from ATLS  Myocardial contusion  Traumatic aortic rupture  Tracheal bronchial tear  Diagphragmatic injury  Esophageal injury  Pulmonary contusion Detected in the secondary survey

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  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

Flail chest

Flail Chest - detail

PLEURAL EFFUSION, PYOTHORAX & PNEUMOTHORAX

Pleural cavity

Pleural space

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)

Inflammation of pleura  Pleuritis sicca  Cause: viral infection  Symptoms:  Pleuritic chest pain  Pleural friction rub  Therapy:  Symptomatic

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

 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

 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)

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

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

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