1. THORACIC TRAUMA

2. YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!

3. 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

4. MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS

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

6. Major Anatomy and Physiology of the Chest

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

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

10. 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...

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

12. 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

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

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

17. Tension Pneumothorax Following Stab Wound

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

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

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

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

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

23. RGR MEDIC
CHEST TUBE INSERTION

25. 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

26. NEEDLE THORACENTESIS

27. NEEDLE THORACENTESIS

28. 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

29. QUESTIONS?