CHEST TRAuMA 1

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CHEST TRAuMA i : 

CHEST TRAuMA i Dr. Assaad Samaha

Chest Trauma : 

Chest Trauma Introduction Anatomy Pathophysiology Causes Symptoms Diagnosis Management Complications

Introduction : 

Introduction Chest injuries are serious injuries First report case 3000BC STAB WOUND TO THE STERNUM Vital Structures Heart, Great Vessels, Esophagus, Tracheobronchial Tree, & Lungs Thoracic trauma is 25% for all trauma death 160 000/y 70% of thoracic trauma result from automobile accidents

Why...? : 

Why...?

Anatomy : 

Anatomy Thoracic Skeleton 12 Pair of C-shaped ribs Sternum Manubrium , Body Xiphoid process Intercostal space Artery, Vein and Nerve on inferior margin of each rib Thoracic Inlet Thoracic Outlet Topographical Thoracic Reference Lines Midclavicular line Anterior axillary line Mid-axillary line Posterior axillary line

Anatomy : 

Anatomy Diaphragm Muscular, Separates abdomen from the thoracic cavity Affixed to the lower border of the rib cage Muscles of respiration Diaphragm Intercostal muscles Contract to elevate the ribs and increase thoracic diameter Increase depth of respiration Sternocleidomastoid Raise upper rib and sternum

Anatomy : 

Anatomy Major muscle of respiration Draws downward during inspiration Moves upward during exhalation

Anatomy : 

Anatomy Mediastinum Central space within thoracic cavity Boundaries Lateral: Lungs Inferior: Diaphragm Superior: Thoracic outlet Structures Heart Great Vessels Esophagus Trachea Nerves Vagus Phrenic Thoracic Duct

Anatomy : 

Anatomy Trachea Hollow & cartilage supported structure Bronchi Right & left extend for 3 centimeters Enters lungs at Pulmonary Hilum Also where pulmonary arteries & veins enter Further subdivide and terminate as alveoli Basic unit of structure & function in the lungs Single cell membrane

Anatomy : 

Anatomy

Physiology of Respiration : 

Physiology of Respiration Inhalation Diaphragm contracts and flattens Intercostals contract expanding ribcage Thorax volume increases Less internal pressure than atmospheric Air enters lungs Exhalation Musculature relaxes Diaphragm & intercostals return to normal Greater internal pressure than atmospheric Air exits lungs

Pathophysiology : 

Pathophysiology Blunt Trauma Results from kinetic energy forces Age Factors Pediatric Thorax: More cartilage = Absorbs forces Geriatric Thorax: Calcification & osteoporosis = More fractures

Blunt trauma : 

Blunt trauma Subdivision Mechanisms Blast Pressure wave causes tissue disruption Tear blood vessels & disrupt alveolar tissue Disruption of tracheobronchial tree Traumatic diaphragm rupture Crush (Compression) Body is compressed between an object and a hard surface Direct injury of chest wall and internal structures Deceleration Body in motion strikes a fixed object Blunt trauma to chest wall Internal structures continue in motion Ligamentum Arteriosum shears aorta

Pathophysiology : 

Pathophysiology Penetrating Trauma Low Energy Arrows, knives, handguns Injury caused by direct contact and cavitation High Energy Military, hunting rifles & high powered hand guns Extensive injury due to high pressure cavitation

Penetrating Injuries : 

Penetrating Injuries 3 meters from weapon Massive tissue destruction weapon

Injuries Associated with Thoracic Trauma : 

Injuries Associated with Thoracic Trauma 1 rib fracture 2 Flail chest 3 Closed pneumothorax 4 Open pneumothorax (including sucking chest wound) 5 Tension pneumothorax 6 Pneumomediastinum 7 Hemothorax 8 Hemopneumothorax 9 Laceration of vascular structures 10 Tracheobronchial tree lacerations 11 Esophageal lacerations 12 Penetrating cardiac injuries 13 Pericardial tamponade 14Spinal cord injuries 15 Diaphragm trauma 16 Intra-abdominal penetration with associated organ injury

Chest trauma causes : 

Chest trauma causes Accidents (car , motorbike…) Fall Bullet Knife blade Shrapnel Blast Iatrogenic chest trauma

Chest trauma causes : 

Chest trauma causes Bullet

Iatrogenic chest trauma : 

Iatrogenic chest trauma

Signs & Symptoms : 

Signs & Symptoms 1 Breathing difficulties 2 Pain at site. This usually increases with movement 3 Bruising 4 Deformity 5 Paradoxical breathing 6 Severe breathing difficulties 7 Bluish skin colour due to decreased levels of oxygen in blood 8 Reduced levels of consciousness 9 Enlarged neck veins 10 Reduced chest movement (injured side) 11 Cyanosis 12 Severe Dyspnea 13 Absent Breath sounds 14 Tachypnea 15 Tachycardia 16 Accessory Muscle Use 17 Hypotension 18 Tracheal Deviation

Signs & Symptoms : 

Signs & Symptoms Cyanosis Enlarged neck veins

Diagnosis : 

Diagnosis Quick history Quick physical exam CXR LAB CT Scan Angiography Echocardiography taping

Management : 

Management Prehospital care A B C 1 Assess any dangers to yourself, others and victim 2 Check for victim response . 3 Check airways by look, listen and feel. 4 Assess possible signs and symptoms. 5 Help casualty into a comfortable position. This can be a semi-sitting position which will assist in breathing 6 Ensure the injured side is facing downwards

Management : 

Management 8 Stabilise the injured site by placing a pillow, pad or hand over injured area. 9 Secure the upper arm on the injured side with broad bandage. Tie off on other side of body. 10 An elevation sling can assist the arm on the injured side. 12 Reassure the casualty 13 Flutter-Valve Seal Prehospital care 7 Call an ambulance Call OR team 14 Provide oxygen if available

Management : 

Management Flutter-Valve Seal

Management : 

Management Hospital care True diagnosis (X RAY , LAB...) Blood transfusion Needle decompresion Chest tube Intubation Bronchoscopy Operative repair

Management : 

Management Surgery department 1 Continuous and vigilant respiratory assessment 2 Optimizing oxygenation and ventilation, 3 Maintaining the chest tube system 4 Providing comfort and emotional support 5 Maintaining surveillance for complications

Complications of thoracic trauma : 

Complications of thoracic trauma Atelectasis ARDS Pneumonia Infarction Lung abscess Arteriovenous fistula Bronchial stenosis Tracheoesophageal fistula Empyema Chylothorax Diaphragmatic hernias Air embolism Pseudoaneurysm

Needle decompresion : 

Needle decompresion

Chest drain : 

Chest drain

hemothorax : 

hemothorax

Needle decompression : 

Needle decompression

thanks : 

thanks

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