Lunch and Learn 6 Jan2009

Topics Primary survey Airway obstruction Tension pneumothorax Open pneumothorax Flail Chest Hemothorax Cardiac tamponade

Secondary Survey Identify and treat Simple pneumothorax Hemothorax Pulmonary contusion Tracheobronchial disruption Blunt cardiac injury Traumatic aortic disruption Diaphragmatic injury

Primary survey You must treat hypoxia in your primary survey, if no ariway and oxygenation established, don’t move on to your secondary survey!

Primary Survey Establish airway: intubate or cricothyroidotomy. Breathing: Confirm tube placement Auscultate lungs: this is when you will pick up pneumothoraces, flail chest, hemothorax.

Primary Survey Tension pneumothorax Immediate tx? Definitive tx?

Primary Survey Open pneumothorax Treatment? Immediate, definitive?

Primary Survey Flail Chest: 2 ribs, broken in 2 places. Paradoxical motion? Treatment? Immediate? Long term?

Primary Survey Circulation: Hemothorax Vital signs? Massive >1500ml, requires thoracotomy Treatment? Immediate?

Primary Survey Circulation Cardiac tamponade- what happens? Beck’s triad? Pulsus paradoxus: decrease in SBP >10 during inspiration Immediate dx and tx: pericardiocentesis vs ultrasound. Will require thoracotomy.

Secondary Survey Includes all xrays, ABGs, FAST, labs, etc. Should have definitive airway at this point and IV’s. Looking for areas of bleeding in closed cavities, fractures, etc.

Secondary Survey: Thoracic Simple pneumothorax May discover on chest x-ray

Secondary Survey Hemothorax: tx with CT

Secondary Survey Pulmonary contusion: persistent hypoxia Tracheobronchial tree injury: hemoptysis, subcutaneous emphysema, tension pneumo Blunt cardiac injury: may show ECG abnormalities, at risk for dysrhythmias. Aortic rupture Traumatic diaphragmatic injury.

Other Manifestations of Chest Injuries Subcutaneous emphysema: probably will need chest tube, especially if intubating. Rib, sternum, Scapular fx: severe injuries, think about trauma to underlying organs and vessels, spinal injury. Esophageal trauma: gastric contents empty into thoracic cavity. Will require thoracotomy and repair.