Chest trauma PTT

ObjectivesObjectives
 Anatomy of ThoraxAnatomy of Thorax
 Main Causes of Chest InjuriesMain Causes of Chest Injuries
 S/S of Chest InjuriesS/S of Chest Injuries
 Different Types of Chest InjuriesDifferent Types of Chest Injuries
 Treatments of Chest InjuriesTreatments of Chest Injuries

Anatomy of the chestAnatomy of the chest
Two Lungs (right and left)
Heart
Diaphragm

Anatomy of the chestAnatomy of the chest
Pleural Space

Main Causes of Chest TraumaMain Causes of Chest Trauma
 Blunt TraumaBlunt Trauma- the chest strikes by an- the chest strikes by an
object.object.
 Penetrating TraumaPenetrating Trauma- is an open injury in- is an open injury in
which a foreign body passes through thewhich a foreign body passes through the
body tissue.body tissue.

Blunt traumaBlunt trauma
 Motor vehicle accident, fall, assault withMotor vehicle accident, fall, assault with
blunt object, compression.blunt object, compression.
 Assessment:Assessment:
-dyspnea, respiratory distress.-dyspnea, respiratory distress.
-cough with or without hemoptysis.-cough with or without hemoptysis.
-trachea deviation.-trachea deviation.
-decrease O2 sat.-decrease O2 sat.
-decrease breath sounds on the side of injury.-decrease breath sounds on the side of injury.

 Intervention :Intervention :
-ensure patent airway.-ensure patent airway.
-administer O2 to keep O2 sat more than-administer O2 to keep O2 sat more than
90%.90%.
-begin fluid resuscitation.-begin fluid resuscitation.
-remove clothes to assess injury.-remove clothes to assess injury.
-apply bulky dressing if there is an open-apply bulky dressing if there is an open
wound.wound.
-place pt on semi-fowlers position or position-place pt on semi-fowlers position or position
pt on the injured side if breathing is easierpt on the injured side if breathing is easier
after c-spine has been ruled out.after c-spine has been ruled out.

Penetrating traumaPenetrating trauma
 Knife, gunshot, stick, arrow.Knife, gunshot, stick, arrow.
 Assessment :Assessment :
-rapid, thready pulse.-rapid, thready pulse.
- Decrease B/P.Decrease B/P.
- Narrowed pulse pressure.Narrowed pulse pressure.
- Asymmetric B/P values in arms.Asymmetric B/P values in arms.
- Distended neck veins.Distended neck veins.
- Chest pain.Chest pain.

- Dysrhythmia.Dysrhythmia.
- Bruising.Bruising.
- Open chest wound.Open chest wound.
- Asymmetric chest movement.Asymmetric chest movement.
- Subcutaneous emphysema.Subcutaneous emphysema.
intervention:intervention:
- Monitor vital signs, LOC, O2sat, cardiacMonitor vital signs, LOC, O2sat, cardiac
rhythms, respiratory status, urine output.rhythms, respiratory status, urine output.
- Intubation for respiratory distress.Intubation for respiratory distress.
- Bulky dressing in open wound.Bulky dressing in open wound.

Injuries of chestInjuries of chest
 PneumothoraxPneumothorax
 Open PneumothoraxOpen Pneumothorax
 TensionTension
PneumothoraxPneumothorax
 Flail ChestFlail Chest
 Cardiac TamponadeCardiac Tamponade
 Traumatic AorticTraumatic Aortic
RuptureRupture
 DiaphragmaticDiaphragmatic
RuptureRupture

 Air in the pleuralAir in the pleural
space.space.
 Blunt trauma is mainBlunt trauma is main
causecause

S/S of PneumothoraxS/S of Pneumothorax
 Chest PainChest Pain
 DyspneaDyspnea
 TachypneaTachypnea
 Decreased Breath Sounds on Affected SideDecreased Breath Sounds on Affected Side
 hyperresonance to percussion.hyperresonance to percussion.

InterventionIntervention
 chest tube insertion with flutter valve orchest tube insertion with flutter valve or
chest drainage system.chest drainage system.

Open PneumothoraxOpen Pneumothorax
 Opening in chestOpening in chest
cavity that allows aircavity that allows air
to enter pleural cavityto enter pleural cavity
 Causes the lung toCauses the lung to
collapse due tocollapse due to
increased pressure inincreased pressure in
pleural cavitypleural cavity
 Can be life threateningCan be life threatening
and can deteriorateand can deteriorate
rapidlyrapidly

Inhale

Exhale

Open PneumothoarxOpen Pneumothoarx
Inhale

Open PnuemothoraxOpen Pnuemothorax
Inhale

S/S of Open PneumothoraxS/S of Open Pneumothorax
 DyspneaDyspnea
 Sudden sharp painSudden sharp pain
 Subcutaneous EmphysemaSubcutaneous Emphysema
 Decreased lung sounds on affected sideDecreased lung sounds on affected side
 Red Bubbles on Exhalation from woundRed Bubbles on Exhalation from wound
( a.k.a. Sucking chest wound)( a.k.a. Sucking chest wound)

Subcutaneous EmphysemaSubcutaneous Emphysema
 Air collects in subcutaneous fat fromAir collects in subcutaneous fat from
pressure of air in pleural cavitypressure of air in pleural cavity
 Feels like rice crispies or bubble wrapFeels like rice crispies or bubble wrap
 Can be seen from neck to groin areaCan be seen from neck to groin area

Sucking Chest WoundSucking Chest Wound

Treatment for OpenTreatment for Open
 High Flow oxygen.High Flow oxygen.
 Apply occlusive dressing to wound.Apply occlusive dressing to wound.

Occlusive DressingOcclusive Dressing

Tension PneumothoraxTension Pneumothorax
 Air builds in pleural space with no whereAir builds in pleural space with no where
for the air to escapefor the air to escape
 Results in collapse of lung on affected sideResults in collapse of lung on affected side
that results in pressure on mediastium,thethat results in pressure on mediastium,the
other lung, and great vesselsother lung, and great vessels

Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..

Heart is being
compressed
The trachea is
pushed to
the good side

S/S of Tension PneumothoraxS/S of Tension Pneumothorax
 Anxiety/RestlessnessAnxiety/Restlessness
 Severe DyspneaSevere Dyspnea
 Absent Breath soundsAbsent Breath sounds
on affected sideon affected side
 TachycardiaTachycardia
 CyanosisCyanosis
 Accessory Muscle UseAccessory Muscle Use
 JVDJVD
 Narrowing PulseNarrowing Pulse
PressuresPressures
 HypotensionHypotension
 Tracheal DeviationTracheal Deviation

Intervention for TensionIntervention for Tension
 Medical emergencyMedical emergency
 Needle decompression followed by chestNeedle decompression followed by chest
tube insertion with chest drainage system.tube insertion with chest drainage system.

Needle DecompressionNeedle Decompression
 Locate 2-3 Intercostal space midclavicular lineLocate 2-3 Intercostal space midclavicular line
 Cleanse area using aseptic techniqueCleanse area using aseptic technique
 Insert catheter ( 14g or larger) at least 3” in lengthInsert catheter ( 14g or larger) at least 3” in length
over the top of the 3over the top of the 3rdrd
rib( nerve, artery, vein lierib( nerve, artery, vein lie
along bottom of rib)along bottom of rib)
 Remove Stylette and listen for rush of airRemove Stylette and listen for rush of air
 Place Flutter valve over catheterPlace Flutter valve over catheter
 Reassess for ImprovementReassess for Improvement

Needle DecompressionNeedle Decompression

HemothoraxHemothorax
 Occurs when pleural space fills with bloodOccurs when pleural space fills with blood
 Usually occurs due to lacerated bloodUsually occurs due to lacerated blood
vessel in thoraxvessel in thorax
 As blood increases, it puts pressure on heartAs blood increases, it puts pressure on heart
and other vessels in chest cavityand other vessels in chest cavity
 Each Lung can hold 1.5 liters of bloodEach Lung can hold 1.5 liters of blood

May put pressure on the heart

Lots of blood vessels
Where does the blood come
from.

S/S of HemothoraxS/S of Hemothorax
 Anxiety/RestlessnessAnxiety/Restlessness
 dyspneadyspnea
 Diminished Breath Sounds on AffectedDiminished Breath Sounds on Affected
SideSide
 Shock depending on blood volume lost.Shock depending on blood volume lost.
 Flat Neck VeinsFlat Neck Veins

Intervention for HemothoraxIntervention for Hemothorax
 Chest tube insertion with chest drainage system .Chest tube insertion with chest drainage system .
 Treatment of hypovolemia as necessary .Treatment of hypovolemia as necessary .

Flail ChestFlail Chest
The breaking of 2The breaking of 2
or more ribs in 2or more ribs in 2
or more placesor more places

S/S of Flail ChestS/S of Flail Chest
 Shortness of BreathShortness of Breath
 Paradoxical MovementParadoxical Movement
 Bruising/SwellingBruising/Swelling
 Maybe associated with hemothorax,Maybe associated with hemothorax,
pneumothorax.pneumothorax.

Intervention for Flail ChestIntervention for Flail Chest
 O2 as needed to maintain O2 sat.O2 as needed to maintain O2 sat.
 Monitor Patient for signs of Pneumothorax ,Monitor Patient for signs of Pneumothorax ,
hemothorax or Tension Pneumothorax.hemothorax or Tension Pneumothorax.
 AnalgesiaAnalgesia
 IntubationIntubation
 Treat associated injuries.Treat associated injuries.

Pericardial TamponadePericardial Tamponade
Blood and fluidsBlood and fluids
leak into theleak into the
pericardial sacpericardial sac
which surrounds thewhich surrounds the
heart.heart.
As the pericardialAs the pericardial
sac fills, it causessac fills, it causes
the sac to expandthe sac to expand
until it cannotuntil it cannot
expand anymoreexpand anymorepericardial sac

Once the pericardialOnce the pericardial
sac can’t expandsac can’t expand
anymore, the fluidanymore, the fluid
starts puttingstarts putting
pressure on the heartpressure on the heart
Now the heart can’tNow the heart can’t
fully expand andfully expand and
can’t pumpcan’t pump
effectively.effectively.

With poor pumping theWith poor pumping the
blood pressure starts toblood pressure starts to
drop.drop.
The heart rate starts toThe heart rate starts to
increase to compensateincrease to compensate
but is unablebut is unable
The patient’s level ofThe patient’s level of
conscious drops, andconscious drops, and
eventually the patienteventually the patient
goes in cardiac arrestgoes in cardiac arrest

S/S of Pericardial TamponadeS/S of Pericardial Tamponade
 Distended Neck VeinsDistended Neck Veins
 Respiratory Rate increasesRespiratory Rate increases
 HypotensionHypotension
 Increase central venous pressure .Increase central venous pressure .

Intervention of cardiacIntervention of cardiac
tamponadetamponade
 Medical emergency.Medical emergency.
 Cardiac MonitorCardiac Monitor
 pericardiocentesis, with surgical repair aspericardiocentesis, with surgical repair as
appropriate.appropriate.

PericardiocentesisPericardiocentesis
 Using aseptic technique, Insert at least 3” needleUsing aseptic technique, Insert at least 3” needle
at the angle of the Xiphoid Cartilage at the 7at the angle of the Xiphoid Cartilage at the 7thth
ribrib
 Advance needle at 45 degree towards the clavicleAdvance needle at 45 degree towards the clavicle
while aspirating syringe till blood return is seenwhile aspirating syringe till blood return is seen
 Continue to Aspirate till syringe is full thenContinue to Aspirate till syringe is full then
discard blood and attempt again till signs of nodiscard blood and attempt again till signs of no
more bloodmore blood
 Closely monitor patient due to small about ofClosely monitor patient due to small about of
blood aspirated can cause a rapid change in bloodblood aspirated can cause a rapid change in blood
pressurepressure

Traumatic Aortic RuptureTraumatic Aortic Rupture
If enough motion is placed on
the heart (.. Deceleration
From a motor vehicle
accident) the heart may tear
away from the aorta.

Traumatic Aortic RuptureTraumatic Aortic Rupture
The chances of survival are
very slim and are based on the
degree of the tear.
If there is just a small tear then
the patient may survive. If the
aorta is completely transected
then the patient will die .

S/S Of Traumatic Aortic RuptureS/S Of Traumatic Aortic Rupture
 Burning or Tearing Sensation in chest orBurning or Tearing Sensation in chest or
shoulder bladesshoulder blades
 Rapidly dropping Blood PressureRapidly dropping Blood Pressure
 Pulse Rapidly IncreasingPulse Rapidly Increasing
 Rapid Loss of ConsciousnessRapid Loss of Consciousness

Treatment of Traumatic AorticTreatment of Traumatic Aortic
RuptureRupture
 Pain relief.Pain relief.
 Blood transfusion if necessary .Blood transfusion if necessary .
 Surgical aortic resection and repairSurgical aortic resection and repair
endovascular aortic dissection repair.endovascular aortic dissection repair.

Diaphragmatic RuptureDiaphragmatic Rupture
 A tear in the Diaphragm that allows theA tear in the Diaphragm that allows the
abdominal organs enter the chest cavityabdominal organs enter the chest cavity
 More common on Left side due to liverMore common on Left side due to liver
helps protect the right side of diaphragmhelps protect the right side of diaphragm
 Associated with multipile injury patientsAssociated with multipile injury patients

Diaphragm RuptureDiaphragm Rupture

S/S of Diaphragmatic RuptureS/S of Diaphragmatic Rupture
 Abdominal PainAbdominal Pain
 Shortness of breathShortness of breath
 Decreased Breath Sounds on side of ruptureDecreased Breath Sounds on side of rupture
 Bowel Sounds heard in chest cavityBowel Sounds heard in chest cavity

Treatment of DiaphragmaticTreatment of Diaphragmatic
RuptureRupture
 Airway management including IntubationAirway management including Intubation
 Cardiac MonitorCardiac Monitor
 Observe for Pneumothorax due toObserve for Pneumothorax due to
compression on lung by abdominal contentscompression on lung by abdominal contents
 Treat Associated InjuriesTreat Associated Injuries
 Possible insertion of NG tube to helpPossible insertion of NG tube to help
decompress the stomach to relieve pressuredecompress the stomach to relieve pressure

SummarySummary
Chest Injuries are common and often life threateningChest Injuries are common and often life threatening
in trauma patients. So, Rapid identification andin trauma patients. So, Rapid identification and
treatment of these patients is paramount to patienttreatment of these patients is paramount to patient
survival. Airway management is very important andsurvival. Airway management is very important and
aggressive management is sometimes needed foraggressive management is sometimes needed for
proper management of most chest injuries.proper management of most chest injuries.

The ENDThe END
 Questions?Questions?
 CommentsComments

Chest trauma PTT

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Chest trauma PTT