{[ promptMessage ]}

Bookmark it

{[ promptMessage ]}

chest_trauma - Chest Trauma Chest Trauma Gráinne Murphy...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Chest Trauma Chest Trauma Gráinne Murphy Final Med April 2002 Introduction Introduction Chest trauma is often sudden and dramatic s Accounts for 25% of all trauma deaths s 2/3 of deaths occur after reaching hospital s Serious pathological consequnces: ­hypoxia, hypovolaemia, myocardial failure s Mechanism of Injury Mechanism of Injury Penetrating injuries s E.g. stab wounds etc. s Primarily peripheral lung s Haemothorax s Pneumothorax s Cardiac, great vessel or oesophageal injury Blunt injuries Either: ­ direct blow (e.g. rib fracture) ­ deceleration injury or ­ compression injury s Rib fracture is the most common sign of blunt thoracic trauma s Fracture of scapula, sternum, or first rib suggests massive force of injury s Chest wall injuries Chest wall injuries s Rib fractures s Flail chest s Open pneumothorax Rib fractures Rib fractures Most common thoracic injury s Localised pain, tenderness, crepitus s CXR to exclude other injuries s Analgesia..avoid taping s Underestimation of effect s Upper ribs, clavicle or scapula fracture: suspect vascular injury s Flail chest Flail chest Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration s Significant force required s Usually diagnosed clinically s Rx: ABC Analgesia s Flail chest Flail chest Flail Chest - detail Open pneumothorax Open pneumothorax Defect in chest wall provides a direct communication between the pleural space and the environment s Lung collapse and paroxysmal shifting of mediastinum with each respiratory effort ± tension pneumothorax s “Sucking chest wound” s Rx: ABCs…closure of wound…chest drain s Lung injury Lung injury Pulmonary contusion s Pneumothorax s Haemothorax s Parenchymal injury s Trachea and bronchial injuries s Pneumomediastinum s Pneumothorax Pneumothorax Air in the pleural cavity s Blunt or penetrating injury that disrupts the parietal or visceral pleura s Unilateral signs: ↓ movement and breath sounds, resonant to percussion s Confirmed by CXR s Rx: chest drain s Pneumothorax Pneumothorax Tension pneumothorax Tension pneumothorax Air enters pleural space and cannot escape s P/C: chest pain, dyspnoea s Dx: ­ respiratory distress ­ tracheal deviation (away) ­ absence of breath sounds ­ distended neck veins ­ hypotension s s s s s 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 Haemothorax Blunt or penetrating trauma s Requires rapid decompression and fluid resuscitation s May require surgical intervention s Clinically: hypovolaemia absence of breath sounds dullness to percussion s CXR may be confused with collapse s Heart, Aorta & Diaphragm Heart, Aorta & Diaphragm Blunt cardiac injury ­ contusion ­ ventricular, septal or valvular rupture s Cardiac tamponade s Ruptured thoracic aorta s Diaphragmatic rupture s Cardiac Tamponade Cardiac Tamponade Blood in the pericardial sac s Most frequently penetrating injuries s Shock, ↑ JVP, PEA, pulsus paradoxus s Classically, Beck’s triad: ­ distended neck veins ­ muffled heart sounds ­ hypotension s Rx: Volume resuscitation Pericardiocentesis s Cardiac tamponade Cardiac tamponade Aortic rupture Aortic rupture Usually blunt trauma involving deceleration forces; especially RTAs s ~90% die within minutes s Most common site near ligamentum arteriosum s Dx: clinical suspicion, CXR, aortography, contrast CT or TOE s Rx: surgical…poor prognosis s Aortic rupture Aortic rupture Iatrogenic trauma Iatrogenic trauma NG tubes: ­coiling ­endobronchial placement ­pneumothorax s Chest tubes: ­ subcutaneous ­ intraparenchymal ­ intrafissural s Central lines: ­ neck ­ coronary sinus ­ pneumothorax s Line in jugular vein Line in jugular vein Misplaced nasogastric tube Misplaced nasogastric tube Chest trauma: summary Chest trauma: summary Common s Serious s Primary goal is to provide oxygen to vital organs s Remember Airway Breathing Circulation s Be alert to change in clinical condition s ...
View Full Document

  • Fall '11
  • Dr.Aslam
  • Tension pneumothorax, Pulmonary contusion, Flail Chest, Chest trauma, Chest Trauma Chest, chest Flail chest

{[ snackBarMessage ]}

Ask a homework question - tutors are online