chest_trauma - Chest Trauma Chest Trauma Gráinne Murphy...

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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 ...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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