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

Decreased cardiac output and shock and pt dies

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Unformatted text preview: sels leads to decreased cardiac output and shock and pt dies Tension pneumothorax Source: Rosen Haemothorax Accumulation of blood in pleural space Can cause severe hypovolemia, hypovolemic shock, and decrease vital capacity Generally due to injured lung parenchyma – usually self-limiting More severe bleeding from intercostal and internal mammary arteries Uncommonly from great vessels Haemothorax - Management A – control airway if necessary C – restore circulating volume n Autotransfusion available in some centres Closed-tube thoracostomy to evacuate blood – for all unstable or symptomatic patients Large volume drainage may necessitate thoracotomy Indications for Thoracotomy Immediate drainage of more than >20ml/kg of blood (> 1500 mls in adult) Persistent bleeding >7ml/kg/hour (>200 mls/hr for 2-4 hrs in adult) Increasing haemothorax seen on x-ray studies Patient remains hypotensive despite volume replacement Decompensation after initial response to resuscitation Tracheobronchial Injury Blunt or penetrating trauma to chest or neck 30% mortality (50% in first hour) Hoarseness, dyspnea, hemoptysis, blood in larynx seen on larynxostomy, subcutaneous emphysema, pneumothorax not improving with chest tube Needs transfer to hospital ASAP if suspected (with O2) – surgical management Pulmonary contusion Caused by blunt thoracic trauma Pathophysiology n n n n n n Hemorrhage – blood running into alveolar spaces Edema Progressive accumulation of interstitial fluid Hypoxemia – b/c lungs not working due to blood and oedema Decreased pulmonary vascular flow Respiratory failure Pulmonary contusion Treatment n n Should be in Hospital – b/c need high flow oxygen Ventil...
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This document was uploaded on 01/10/2014.

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