2. Chest Injuries

3. Introduction n Chest trauma is often sudden and dramatic n Accounts for 25% of all trauma deaths n 2/3 of deaths occur after reaching hospital n Serious pathological consequences; hypoxia, hypovolaemia, myocardial failure n The most common type of injuries is blunt. n Fracture of scapula, sternum, or first rib suggests massive force of injury

4. n Blunt injuries: can fracture ribs, sternum and costal cartilage, damage airways, lungs, great vessels and heart. n Penetrating injuries: bullets, knives, … can damage internal organs. n Compression: ribs and sternum fracture, internal organ injuries.

5. Types of chest injuries n Closed chest injuries –Ribs and sternum fracture –Flail chest n Open chest injuries –Pneumothorax –Tension pneumothorax n Injuries within the chest cavity –Pneumothorax –Tension pneumothorax –Hemothorax –Traumatic asphyxia –Cardiac tamponade –Aortic injury and dissection

6. Rib & sternal fractures n Most common thoracic injury n S&S: Localised pain, dyspnes, tenderness, crepitus, chest wall ecchymosis n Dx Studies: CXR to exclude other injuries n Rx: Analgesia. avoid taping n Underestimation of effect n Upper ribs, clavicle or scapula fracture: suspect vascular injury

7. Flail Chest n It is fracture of two or more adjacent ribs in two or more places that allows for free movement of fractures segment n S & S: –Paradoxical chest movements –Dyspnea –Chest pain n Care: –ABC –Analgesics –Early assessment –Administer oxygen –Stabilize area with bulky dressing –Monitoring

8. Flail Chest

9. Open Chest Wound n Sucking chest wound: is an open chest wound in which air is sucked into the chest cavity. n S & S: –Presence of chest wound –Sucking chest wound may or may be not available –Patient may be gasping for air n Care: –ABC –Seal open chest wound quickly –Apply occlusive dressing –Administer high concentrated oxygen –Care for shock –Transport as soon as possible

10. Sucking Chest Wound

11. Pneumothorax n Pneumothorax: air in the chest cavity n Tension pneumothorax: air in the chest cavity prevented from escaping. n S & S: respiratory difficulty, rapid weak pulse, cyanosis, low BP, narrow pulse pressure, distended neck vein, tracheal deviation, reduced breathing sounds, hyper resonance, n Rx: ABC, closure of wound, chest drain.

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

13. Hemothorax n Blood collection in the pleural space. n S & S: Dyspnea, tachypnea, Chest pain, Signs of shock, Tracheal deviation, Decreased breath sounds on the injured side, coughing up blood, dullness. n Rx: rapid decompression and fluid resuscitation

14. Traumatic Asphyxia n Caused by sudden compression of chest n S & S: distended neck veins, dark blue upper body, bloodshot and bulging of eyes, swollen blue tongue and lips, chest deformity n Rx: ABC, relieve pressure

15. Cardiac Tamponade n Blood collection within pericardial sac n S & S: Beck’s triad: (distended neck veins, muffled heart sounds, low BP), very weak pulse, decreasing pulse pressure, PEA, Shock. n Rx: Volume resuscitation, Pericardiocentesis

16. Cardiac Tamponade

17. Aortic Injury and Dissection n Usually blunt trauma involving deceleration forces; especially RTAs n ~90% die within minutes n S & S: tearing chest pain radiating to the back, difference in BP between Rt & Lt arm, palpable pulsating mass, cardiac arrest. n Rx: surgical…poor prognosis

18. Aortic Rupture

19. Care of injuries within chest cavity n Maintain open airway n Administer high concentration oxygen n Care of shock n Transport

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

21. Ruptured Diaphragm n It is a potentially life-threatening injury that may result from forces that penetrate the body, such as gunshot wounds, or from acceleration or deceleration forces, such as motor vehicle crashes. n Blunt injuries are more likely to injure the left leaf of the diaphragm since the right leaf is somewhat protected by the liver. n A rupture or tear of the diaphragm may allow Herniation of abdominal contents into the thorax. n Herniation may result in respiratory' compromise. n Mediastinal structures may shift lo the opposite side of the injury.

22. S & S of Ruptured Diaphragm n Dyspnea or orthopnea n Dysphagia n Abdominal pain n Sharp epigastric or chest pain radiating to the left shoulder (Kehr's sign) n Bowel sounds in the lower to the middle chest n Decreased breath sounds on the injured side

23. Line in jugular vein & Misplaced NGT