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Chest Trauma

Chest trauma accounts for 25% of all trauma deaths and is often sudden and dramatic. Common injuries include rib fractures, pneumothorax, hemothorax, and flail chest from blunt trauma or penetrating injuries such as stab wounds. Management priorities are airway, breathing, and circulation to ensure oxygen delivery to vital organs. Clinicians must be alert to changes in condition as chest trauma can have serious pathological consequences.

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687 views25 pages

Chest Trauma

Chest trauma accounts for 25% of all trauma deaths and is often sudden and dramatic. Common injuries include rib fractures, pneumothorax, hemothorax, and flail chest from blunt trauma or penetrating injuries such as stab wounds. Management priorities are airway, breathing, and circulation to ensure oxygen delivery to vital organs. Clinicians must be alert to changes in condition as chest trauma can have serious pathological consequences.

Uploaded by

drpravalk
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Chest Trauma

Thoracic surgery
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
Mechanism of Injury
Penetrating injuries
 E.g. stab wounds etc.
 Primarily peripheral lung
 Haemothorax
 Pneumothorax
 Cardiac, great vessel or oesophageal
injury
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
Chest wall injuries

 Rib fractures
 Flail chest
 Open pneumothorax
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
Flail chest
 Multiple rib fractures produce a mobile
fragment which moves paradoxically
with respiration
 Significant force required
 Usually diagnosed clinically
 Rx: ABC
Analgesia
Flail chest
Flail Chest - detail
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
Lung injury
 Pulmonary contusion
 Pneumothorax
 Haemothorax
 Parenchymal injury
 Trachea and bronchial injuries
 Pneumomediastinum
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
Pneumothorax
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
 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
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
Heart, Aorta & Diaphragm
 Blunt cardiac injury
- contusion
- ventricular, septal or valvular
rupture
 Cardiac tamponade
 Ruptured thoracic aorta
 Diaphragmatic rupture
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
Cardiac tamponade
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
Aortic rupture
Iatrogenic trauma
 NG tubes: -coiling -endobronchial
placement -pneumothorax
 Chest tubes: - subcutaneous -
intraparenchymal - intrafissural
 Central lines: - neck -
coronary sinus -
pneumothorax
Line in jugular vein
Misplaced nasogastric tube
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

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