Lecture52_Chest Trauma, Cardiac Tamponade & Tension Pneumothorax - Impact on Circulation

Lecture52_Chest Trauma, Cardiac Tamponade & Tension Pneumothorax - Impact on Circulation

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Chest Trauma, Tension Pneumothorax and Cardiac Tamponade Dr. Roger Irvine Consultant Cardiothoracic Surgeon UWI
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THORACIC TRAUMA- FACTS Second leading cause of trauma deaths Accounts for 25% of all trauma deaths 85% can be managed outside of the operating room Divided into Blunt and Penetrating Trauma Major causes of Blunt Thoracic Trauma: n Steering wheel, bicycle handlebars, baseball Major causes of Penetrating Trauma: n GSW and Stabbings
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Chest Trauma - classification 50% - Chest wall injuries 26% - Pulmonary injuries 20% - Cardiovascular injuries 4% - Other (esophageal/diaphragmatic injuries)
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Rapid detection essential in decreasing morbidity and mortality resulting from chest trauma. Only < 10% of Blunt chest trauma and 15 – 30% of Penetrating chest trauma (lacerations to great vessels mostly) needs operative intervention
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Thoracic Anatomy Cavity is bounded by ribs, spine, and diaphragm Pleura n Parietal n Visceral n Potential space can hold 3 liters on each side Right lung – 3 lobes Left lung – 2 lobes Mediastinum - Heart Great vessels Esophagus Trachea Main stem bronchi
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PHYSIOLOGY Respiration n Requires intercostal muscles and diaphragm n Operates on pressure gradient n During exhalation, diaphragm elevated to 4th intercostal space n Driven by PCO2 levels (chemoreceptors in brainstem) n COPD patients driven by PO2 receptors in aortic arch and carotid arteries
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Initial Management Same as any trauma situation A. Airway stabilization (c-spine control!!) B. Breathing and ventilation C. Circulation with hemorrhage control D. Disability/neurologic status E. Exposure
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Chest Wall Injury Intact chest wall absolutely essential for normal respiration – maintains the negative pressure 50% of individuals with thoracic trauma will have chest wall injury n 10% minor – e.g. broken rib or so n 35% major – e.g. multiple rib fractures n 5% flail chest Includes Soft tissue injury, Rib Fractures, Sternal Fractures, Sternoclavicular dislocations
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Rib fractures Break at point of impact or posterior angle Ribs 4-9 most commonly broken n Ribs 1-3 well protected by clavicle etc. Marker for severe intrathoracic injury n Ribs 9-12 mobile anteriorly Marker for intraabdominal injury (liver, spleen, kidney) Single rib fracture n May limit ventilation and cough reflex secondary to pain – may lead to pneumonia n Conservative management
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Flail Chest >2 adjacent ribs fractured at two points Mortality 8-35% Respiration adversely affected n Free segment moves paradoxically w/ breathing (decreases volume for expansion when breathing in) n Frequently underlying pulmonary contusion pressure that broke the ribs usually transferred to underlying lung so it will not work properly – faulty oxygen transfer etc. Dx (diagnosis) : n Pain, crepitus, paradoxical movement Observe for Pneumothorax/Tension Pneumothorax
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Flail Chest
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SIMPLE PNEUMOTHORAX SP = Air in the pleural space Affected lung begins to collapse as pleural space expands Caused by puncture wound, rib fracture, or lung defect Simple pneumo usually well tolerated in young,
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