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by: girmaw

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1 : Chest Trauma Gráinne Murphy Final Med April 2002
2 : 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 consequnces: -hypoxia, hypovolaemia, myocardial failure
3 : Mechanism of Injury Penetrating injuries E.g. stab wounds etc. Primarily peripheral lung Haemothorax Pneumothorax Cardiac, great vessel or oesophageal injury
4 : 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
5 : Chest wall injuries Rib fractures Flail chest Open pneumothorax
6 : 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
7 : Flail chest Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration Significant force required Usually diagnosed clinically Rx: ABC Analgesia
8 : Flail chest
9 : Flail Chest - detail
10 : Open pneumothorax Defect in chest wall provides a direct communication between the pleural space and the environment Lung collapse and paroxysmal shifting of mediastinum with each respiratory effort ± tension pneumothorax “Sucking chest wound” Rx: ABCs…closure of wound…chest drain
11 : Lung injury Pulmonary contusion Pneumothorax Haemothorax Parenchymal injury Trachea and bronchial injuries Pneumomediastinum
12 : Pneumothorax Air in the pleural cavity Blunt or penetrating injury that disrupts the parietal or visceral pleura Unilateral signs: ?movement and breath sounds, resonant to percussion Confirmed by CXR Rx: chest drain
13 : Pneumothorax
14 : Tension pneumothorax Air enters pleural space and cannot escape P/C: chest pain, dyspnoea Dx: - respiratory distress - tracheal deviation (away) - absence of breath sounds - distended neck veins - hypotension
15 : 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
16 : Haemothorax Blunt or penetrating trauma Requires rapid decompression and fluid resuscitation May require surgical intervention Clinically: hypovolaemia absence of breath sounds dullness to percussion CXR may be confused with collapse
17 : Heart, Aorta & Diaphragm Blunt cardiac injury - contusion - ventricular, septal or valvular rupture Cardiac tamponade Ruptured thoracic aorta Diaphragmatic rupture
18 : Cardiac Tamponade Blood in the pericardial sac Most frequently penetrating injuries Shock, ?JVP, PEA, pulsus paradoxus Classically, Beck’s triad: - distended neck veins - muffled heart sounds - hypotension Rx: Volume resuscitation Pericardiocentesis
19 : Cardiac tamponade
20 : Aortic rupture Usually blunt trauma involving deceleration forces; especially RTAs ~90% die within minutes Most common site near ligamentum arteriosum Dx: clinical suspicion, CXR, aortography, contrast CT or TOE Rx: surgical…poor prognosis
21 : Aortic rupture
22 : Iatrogenic trauma NG tubes: -coiling -endobronchial placement -pneumothorax Chest tubes: - subcutaneous - intraparenchymal - intrafissural Central lines: - neck - coronary sinus - pneumothorax
23 : Line in jugular vein
24 : Misplaced nasogastric tube
25 : Chest trauma: summary Common Serious Primary goal is to provide oxygen to vital organs Remember Airway Breathing Circulation Be alert to change in clinical condition

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