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Similar to chest trauma.pptx (20)
chest trauma.pptx
- 1. Chest Trauma
- 2. • classified as either blunt or penetrating
- 3. Classification of thoracic injuries 1. Chest wall 2. Pleural space 3. Pulmonary parenchyma 4. Mediastinal structures a. Aerodigestive structures Trachea & bronchi Esophagus b. Vascular structures 3
- 4. BLUNT TRAUMA • Blunt chest trauma results from sudden compression or positive pressure inflicted to the chest wall • Motor vehicle crashes (trauma due to steering wheel, seat belt), falls, and bicycle crashes (trauma due to handlebars) are the most common causes of blunt chest trauma
- 6. Pathophysiology • Hypoxemia from disruption of the airway; – injury to the lung parenchyma, rib cage, and respiratory musculature; massive hemorrhage; collapsed lung; and pneumothorax • Hypovolemia from massive fluid loss from the great vessels, cardiac rupture, or hemothorax • Cardiac failure from cardiac tamponade, cardiac contusion, or increased intrathoracic pressure
- 7. Assessment • When the injury occurred • Mechanism of injury • Level of responsiveness • Specific injuries • Estimated blood loss • Recent drug or alcohol use • Prehospital treatment
- 8. Medical Management • The goals of treatment are to evaluate the patient’s condition and to initiate aggressive resuscitation. – An airway is immediately established with oxygen support and, – in some cases, intubation and ventilatory support. – Re-establishing fluid volume and negative intrapleural
- 9. Rib fractures • Most common injury • Often following blunt thoracic trauma • At the site of force, latterally • 20% mortality in the elderly • Less common in children • 1st to 3rd rib fracture: rare (high mortality rate) – Severe injury – 30% mortality • 5th to 9th . Common site • 10th to 12th rib : associated with laceration of spleen and liver Effect – Poor inspiratory effort – Ineffective cough – Atelectasis – Pneumonia 9
- 10. Clinical manifestation • Hx of trauma to the chest wall • severe pain, point tenderness, and muscle spasm over the area of the fracture, which is aggravated by coughing, deep breathing, and movement. • The area around the fracture may be bruised. • To reduce the pain, the patient splints the chest by breathing in a shallow manner and avoids sighs, deep breaths, coughing, and movement. 10
- 11. Rib fractures CXR: • Lateral or anterior rib fractures will often be missed • Mainly for associated injuries 11
- 12. Rib fractures Treatment • CXR to exclude other injuries (50% sensitive) 1. Strong analgesics 2. Encourage breathing 3. Prophylactic antibiotics 4. Treat associated injuries 12
- 13. Sternal fractures • Usually transverse fracture, majority at the sterno-manubrial junction • Associated injuries: myocardial contusion, cardiac chamber rupture, transaction of the aorta • Dx: X-ray (lateral) Treatment – Exclude life threatening injuries (ECG, CXR) – Pain control – Chest physiotherapy – Reduce fracture manually 13
- 14. Sternal fractures Open reduction Unstable fracture Displacement >1cm Associated lower extremity injury For flail sternum: Internal or external 14
- 15. Flail chest • At least two fractures per rib, in at least two ribs • Creating one floating segment comprised of several rib sections and the soft tissues between them • Anterior and lateral are common • Significant force required and associated with severe lung injury • Pathophysiology – Paradoxical movement of the chest (diagnostic) – Pain 15
- 16. Flail chest • Unstable section of chest wall exhibits paradoxical motion (i.e, it moves in the opposite direction of the uninjured, normal- functioning chest wall) with breathing • Is associated with significant morbidity from pulmonary contusion 16
- 17. Flail chest
- 18. Flail chest Treatment • Good analgesia • Endotracheal intubation with continous positive pressure ventilation for up to three weeks, until the fracture becomes less mobile Indications for endotracheal intubation – Deterioration of pulmonary function – Hypoxia – Hypercarbia _PCO2 >45 mmHg • Fracture fixation 18
- 19. Management of Flail chest • Stabilize the flail segment – Firm gentle manual pressure – Apply IV bags – Place patient with injured site down – Traction – Open fixation • Insert a chest tube 19