1. Thoracic Trauma

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 consequences; hypoxia, hypovolaemia, myocardial failure
The most common type of injuries is blunt.

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

4. Anatomy and Physiology

5. Rib Fractures It is the most common thoracic injury
Fracture of scapula, sternum, or first ribs suggests massive force of injury and suspect vascular injury.
Lower ribs fracture are associated with spleen and liver injury
S & S: chest pain, SOB, chest tenderness and crepitus.
Rx.: pain relief, immobilization, obs. V/S, IV access, oxygen and ventilatory support

6. Flail Chest
It is fracture of two or more adjacent ribs in two or more places that allows for free movement of fractures segment
S & S: Paradoxical chest movements, dyspnea, chest pain, ↑ RR, and hypoxia.
Rx.: ABC, ventilatory support, analgesics, monitoring, IV access

7. Flail Chest

8. Pulmonary Contusion
It implies lung tissue laceration or tear by blunt or penetrating force, bleeding in alveolar space may be present.
The chief abnormality is prevention of gas exchange.
S & S: depends on severity of contusion
Rx.: ventilatory support, monitoring, IVF.

9. Pneumothorax Air collection in the pleural space. Types:
Simple Pneumothorax
Open Pneumothorax (Sucking Chest Wounds)
Tension Pneumothorax

10. Simple Pneumothorax Findings similar to those of rib fracture
S & S: chest pain, ↓ breath sounds on side of injury, tympanic percussion.
Rx.: monitoring (for possible tension pneumothorax development), decompression, oxygen administration, IV access.

11. Open Pneumothorax
A defect in the chest wall results in communication between outside air and pleural space.
Mainly caused by penetrating chest injuries.
S & S: respiratory distress, anxious, tachypnea, ↑ HR, thready pulse, visible wound, audible sucking sounds during inspiration and bubbling during expiration.

12. Open Pneumothorax
Rx.: closing the defect in the chest wall (occlusive dressing), administering oxygen, ventilatory support (PP), monitoring, decompression and IV access and fluids.

13. Tension Pneumothorax
Air enter pleural space and does not vent, causing intrathoracic pressure build up.
Consequences include respiratory distress and shock.
S & S: apprehension, discomfort, chest pain, SOB, agitation, cyanosis, apnea, diminished breath sounds, tracheal deviation, distended neck veins, tympanic on percussion.
Rx.: decompression (2nd or 3rd ICS MCL), oxygen supplement, ventilatory support.

14. Hemothorax Blood collection in the pleural space.
It can accommodate 2500 to 3000 ml.
S & S: chest pain, SOB, diminished breathing sound, dullness to percussion and signs of shock; pallor, confusion, tachycardia and hypotension.
Rx.: high oxygen concentration, ventilatory support, care for shock (IVF, blood), monitoring

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

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

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

18. Ruptured Diaphragm
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 MVC.
Blunt injuries are more likely to injure the left leaf of the diaphragm since the right leaf is somewhat protected by the liver.
A rupture or tear of the diaphragm may allow Herniation of abdominal contents into the thorax which may result in respiratory' compromise.
Mediastinal structures may shift lo the opposite side of the injury.

19. S & S of Ruptured Diaphragm
Dyspnea or orthopnea, dysphagia, abdominal pain, sharp epigastric or chest pain radiating to the left shoulder (Kehr's sign), bowel sounds in the lower to the middle chest, decreased breath sounds on the injured side
Rx.: Surgical Reapir

20. Iatrogenic Trauma
NG tubes: coiling, endobronchial placement, pneumothorax
Chest tubes: subcutaneous, intraparenchymal, intrafissural
Central lines: neck, coronary sinus, pneumothorax