THORACIC TRAUMA

YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!

INTRODUCTION Each year there 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

MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS

REASON As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!

Major Anatomy and Physiology of the Chest

OVERVIEW Causes of Thoracic Trauma Types, Signs and Symptoms, and Management of Thoracic Trauma

CAUSES OF THORACIC TRAUMA: Falls 3 times the height of the patient Blast Injuries overpressure, plasma forced into alveoli Blunt Trauma PENETRATING TRAUMA

OPEN PNEUMOTHORAX Develops when 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...

LARGE VS SMALL Severity is directly proportional to the size of the wound Atmospheric pressure forces air through the wound upon inspiration

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

MANAGEMENT OF SCW Tension Pneumothorax Apply an Asherman Chest Seal Occlusive dressing with a release valve Observe for development of a Tension Pneumothorax

TENSION PNEUMOTHORAX Air within thoracic cavity that cannot exit the pleural space Fatal if not immediately identified, treated, and reassessed for effective management

Tension Pneumothorax Following Stab Wound

EARLY S/S OF TENSION PNEUMOTHORAX ANXIETY! Increased respiratory distress Unilateral chest movement Unilateral decreased or absent breath sounds

LATE S/S OF TENSION PNEUMOTHORAX Jugular Venous Distension (JVD) Tracheal Deviation Narrowing pulse pressure Signs of decompensating shock

JVD & TRACHEAL SHIFT Decreased input and output from the heart with compression of the great vessels

JVD & TRACHEAL SHIFT Increased pressure moves mediastinum and compresses the lung on the uninjured side

MANAGEMENT OF TENSION PNEUMOTHORAX Asherman Chest Seal Needle Decompression High flow oxygen (If available) Bag Valve Mask / Intubation Chest Tube (BN CCP/CASEVAC)

RGR MEDIC CHEST TUBE INSERTION

NEEDLE THORACENTESIS Locate 2nd 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

NEEDLE THORACENTESIS

NEEDLE THORACENTESIS

SUMMARY Reviewed anatomy and 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

QUESTIONS?