1. Perform a Needle Decompression Treat an Open Chest Wound and

2. Major Anatomy of the Chest

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

4. OPEN PNEUMOTHORAX Develops when penetration injury to the chest allows the pleural space to be exposed to atmospheric pressure - “Sucking Chest Wound”

5. 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

6. MANAGEMENT OF SCW Apply an Asherman Chest Seal – Occlusive dressing with a release valve Using an airtight material that will extend at least 2 inches beyond the edge of the wound on all sides – Tape 3 sides of the material

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

10. Tension Pneumothorax

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

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

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

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

15. MANAGEMENT OF TENSION PNEUMOTHORAX Asherman Chest Seal Needle Decompression High flow oxygen (If available) Bag Valve Mask / Intubation

16. Needle Decompression 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

17. Needle Decompression

19. 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 Decompression

20. QUESTIONS?