1. Chest Trauma
Dr. Khayal Al Khayal

2. Introduction Chest trauma is often sudden and dramatic
Accounts for 25% of all trauma deaths
2/3 of deaths occur after reaching hospital
Serious pathological consequnces: -hypoxia, hypovolaemia, myocardial failure

3. Mechanism of Injury Penetrating injuries E.g. stab wounds etc.
Primarily peripheral lung
Haemothorax
Pneumothorax
Cardiac, great vessel or oesophageal injury

4. Blunt injuries
Either: direct blow (e.g. rib fracture) - deceleration injury or compression injury
Rib fracture is the most common sign of blunt thoracic trauma
Fracture of scapula, sternum, or first rib suggests massive force of injury

5. Chest wall injuries
Rib fractures
Flail chest
Open pneumothorax

6. Rib fractures Most common thoracic injury
Localised pain, tenderness, crepitus
CXR to exclude other injuries
Analgesia..avoid taping
Underestimation of effect
Upper ribs, clavicle or scapula fracture: suspect vascular injury

7. Flail chest
Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration
Significant force required
Usually diagnosed clinically
Rx: ABC Analgesia

8. Flail chest

9. Flail Chest - detail

10. Open pneumothorax
Defect in chest wall provides a direct communication between the pleural space and the environment
Lung collapse and paroxysmal shifting of mediastinum with each respiratory effort ± tension pneumothorax
“Sucking chest wound”
Rx: ABCs…closure of wound…chest drain

11. Lung injury Pulmonary contusion Pneumothorax Haemothorax
Parenchymal injury
Trachea and bronchial injuries
Pneumomediastinum

12. Pneumothorax Air in the pleural cavity
Blunt or penetrating injury that disrupts the parietal or visceral pleura
Unilateral signs: movement and breath sounds, resonant to percussion
Confirmed by CXR
Rx: chest drain

13. Pneumothorax

14. Tension pneumothorax Air enters pleural space and cannot escape
P/C: chest pain, dyspnoea
Dx: - respiratory distress tracheal deviation (away) - absence of breath sounds - distended neck veins hypotension

15. Surgical emergency
Rx: emergency decompression before CXR
Either large bore cannula in 2nd ICS, MCL or insert chest tube
CXR to confirm site of insertion

16. Haemothorax Blunt or penetrating trauma
Requires rapid decompression and fluid resuscitation
May require surgical intervention
Clinically: hypovolaemia absence of breath sounds dullness to percussion
CXR may be confused with collapse

17. Heart, Aorta & Diaphragm
Blunt cardiac injury contusion ventricular, septal or valvular rupture
Cardiac tamponade
Ruptured thoracic aorta
Diaphragmatic rupture

18. Cardiac Tamponade Blood in the pericardial sac
Most frequently penetrating injuries
Shock, JVP, PEA, pulsus paradoxus
Classically, Beck’s triad: - distended neck veins - muffled heart sounds - hypotension
Rx: Volume resuscitation Pericardiocentesis

19. Cardiac tamponade

20. Aortic rupture
Usually blunt trauma involving deceleration forces; especially RTAs
~90% die within minutes
Most common site near ligamentum arteriosum
Dx: clinical suspicion, CXR, aortography, contrast CT or TOE
Rx: surgical…poor prognosis

21. Aortic rupture

22. Iatrogenic trauma
NG tubes: -coiling endobronchial placement pneumothorax
Chest tubes: - subcutaneous intraparenchymal intrafissural
Central lines: - neck coronary sinus pneumothorax

23. Line in jugular vein

24. Misplaced nasogastric tube

25. Chest trauma: summary Common Serious
Primary goal is to provide oxygen to vital organs
Remember Airway Breathing Circulation
Be alert to change in clinical condition