Chest trauma

70 % deaths in road traffic accidents are due to thoracic trauma Traumas can be penetrating or blunt

Immediate life threatening injuries Potentially life threatening injuries

Airway obstruction Tension pneumothorax Hemothorax Cardiac temponade Flial chest

Airway obstruction Any entity that causes disruption in the normal flow of air Leads to Hypoxia Hypercapnia

Mechanical removal of obstruction Endotracheal intubation

Air in the pleural space that is under high pressure One way valve injury Due to lung parenchymal or bronchial injury External Trauma Displaces mediastinal structures

Lung collapse Hypoxia Decreased venous return Impaired cardiac function Decreased cardiac output Hypotension Death Life threatening condition

Respiratory distress Cyanosis Decreased or absent lung sounds Hyperresonance on percussion Hypotension

 Thoracocentesis (insertion of a wide bore needle)  Followed by chest intubation

Donot wait for x-ray to make diagnosis of tension pneumothorax

Presence of blood in the pleural space Caused due to trauma leading to injury of internal mammary or intercostal artery

Reduced chest expansion Dull percussion note Absent breath sounds

Intercostal chest tube insertion attached to an underwater seal Thoracotomy in case of massive hemothorax

Accumulation of blood in the pericardial sac Causes compression of the cardiac chamber Decreased cardiac filling, decreased cardiac output Patient presents with hypotension and distended neck veins

Pericardiocentesis Thoracotomy

Multiple rib fractures which produce a mobile fragment This fragment moves paradoxically with respiration Causes lung compression

If the fragment is small and not interfering with respiration then patient is administered good analgesic until segment stabilizes

Tracheobronchial disruption Aortic disruption Diaphragmatic disruption Pulmonary contusion

Disruption at the junction of trachea and the main broncus In the region of the carnia Causes collapsed lung and massive air leak resulting in subcutaneous emphysema

Caused due to deceleration injury Explain mechanism with diagram Tear in the aorta Shock, deviation of the visceras

Trauma to the chest and abdomen causing tear in the diaphragm Diagnosis by chest radiograph showing stomach or colon in the chest

Occurs in 30-75% of all the patients with major chest injury Caused by blunt trauma Produces capillary disruption-intra alveolar hemorrhage-edema-small airway obstruction Chest radiograph shows arterial blood gas analysis Treatment : fluid resuscitation, chest physiotherapy, analgesics

First rib fracture Multiple rib fractures Stove in chest Cervical rib