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Thoracic trauma by dr.saleh bakar
Thoracic trauma can occur from falls, blast injuries, blunt trauma or penetrating trauma. Twenty-five percent of accidental deaths in the US are directly caused by chest injuries. The document discusses open pneumothorax and tension pneumothorax as life-threatening conditions that can develop from chest wounds. Open pneumothorax, also known as a sucking chest wound, occurs when a chest wall penetration exposes the pleural space and allows air exchange. Tension pneumothorax develops when air enters the chest but cannot exit, causing increased pressure. The document reviews signs and symptoms of each condition and emergency management, including applying an occlusive dressing, needle decompression, and chest tube insertion.
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Thoracic trauma by dr.saleh bakar
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- 2. YOU JUST NEVERKNOW WHEN TRAUMA WILL OCCUR!
- 3. INTRODUCTION • Each yearthere are nearly 150,000 accidental deaths in the United States • 25% of these deaths are a direct result of thoracic trauma • An additional 25% of traumatic deaths have chest injury as a contributing factor
- 4. MORTALITY OF CHESTWOUNDS DURING MILITARY CAMPAIGNS 0 10 20 30 40 50 60 70 80 90 100 Total Wounded 79% 63% 56% 25% 12% % Chest Wound Related Deaths Crimean War (1853- 1856) American Civil War (1861-1865) Franco-Prussian War (1870-1871) World War I (1914- 1918) World War II (1939- 1945)
- 5. REASON As a RangerFirst Responder, you must be able to identify and treat penetrating trauma to the chest!
- 6. Major Anatomy andPhysiology of the Chest
- 7. OVERVIEW • Causes ofThoracic Trauma • Types, Signs and Symptoms, and Management of Thoracic Trauma
- 8. CAUSES OF THORACIC TRAUMA: •Falls 3 times the height of the patient • Blast Injuries overpressure, plasma forced into alveoli • Blunt Trauma • PENETRATING TRAUMA
- 10. OPEN PNEUMOTHORAX • Developswhen penetration injury to the chest allows the pleural space to be exposed to atmospheric pressure - “Sucking Chest Wound” • Q- WHAT MAY CAUSE A SCW? • Examples Include: GSW, Stab Wounds, Impaled Objects, Etc...
- 11. LARGE VS SMALL •Severity is directly proportional to the size of the wound • Atmospheric pressure forces air through the wound upon inspiration
- 12. S/S: OPEN PNEUMOTHORAX •Shortness of Breath (SOB) • Pain • Sucking or gurgling sound as air moves in and out of the pleural space through the wound
- 13. MANAGEMENT OF SCW •Apply an Asherman Chest Seal Occlusive dressing with a release valve • Observe for development of a Tension Pneumothorax
- 16. TENSION PNEUMOTHORAX • Airwithin thoracic cavity that cannot exit the pleural space • Fatal if not immediately identified, treated, and reassessed for effective management
- 17. Tension Pneumothorax FollowingStab Wound
- 18. EARLY S/S OFTENSION PNEUMOTHORAX • ANXIETY! • Increased respiratory distress • Unilateral chest movement • Unilateral decreased or absent breath sounds
- 19. LATE S/S OFTENSION PNEUMOTHORAX • Jugular Venous Distension (JVD) • Tracheal Deviation • Narrowing pulse pressure • Signs of decompensating shock
- 20. JVD & TRACHEALSHIFT Decreased input and output from the heart with compression of the great vessels
- 21. JVD & TRACHEALSHIFT Increased pressure moves mediastinum and compresses the lung on the uninjured side
- 22. MANAGEMENT OF TENSION PNEUMOTHORAX •Asherman Chest Seal • Needle Decompression • High flow oxygen (If available) • Bag Valve Mask / Intubation • Chest Tube (BN CCP/CASEVAC)
- 23. RGR MEDIC CHEST TUBEINSERTION
- 25. NEEDLE THORACENTESIS • Locate2nd or 3rd Intercostal Space at the Midclavicular Line • Insert a 14g needle/catheter over the top of the rib (“VAN”) into the pleural space • Listen for air escape (WHOOSH!) • Leave the catheter in place • Reassess
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- 28. SUMMARY • Reviewed anatomyand physiology of the chest • Discussed causes of trauma to the chest • Signs, symptoms, and emergent management of: OPEN PNEUMOTHORAX Asherman Chest Seal TENSION PNEUMOTHORAX Needle Thoracentesis
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