Chest TraumaChest TraumaDr.seyed mostafa Dr.seyed mostafa shiryadishiryadiAssociate professor of Associate professor of surgerysurgeryShahid sadoghi Shahid sadoghi universityuniversityYAZD-IRANYAZD-IRAN!"ectives!"ectivesAnatomy of Thora#Anatomy of Thora#$ain Causes of Chest In"uries$ain Causes of Chest In"uriesS%S of Chest In"uriesS%S of Chest In"uriesDifferent Types of Chest In"uriesDifferent Types of Chest In"uriesTreatments of Chest In"uriesTreatments of Chest In"uriesAnatomy of the chestAnatomy of the chestTwo Lungs (right and left)HeartDiaphragmAnatomy of the chestAnatomy of the chestPleural SpaceAnatomy of the chest$ain Causes of Chest Trauma$ain Causes of Chest TraumaBlunt TraumaBlunt Trauma- Blunt force to chest.- Blunt force to chest.Penetrating TraumaPenetrating Trauma- Projectile that enters - Projectile that enters chest causing small or large hole.chest causing small or large hole.Compression InjuryCompression Injury- Chest is caught - Chest is caught between two objects and chest is between two objects and chest is compressed.compressed.In"uries of chestIn"uries of chestSimp&e%C&osed Simp&e%C&osed 'neumothora#'neumothora#pen 'neumothora#pen 'neumothora#Tension 'neumothora#Tension 'neumothora#(&ai& Chest(&ai& ChestCardiac TamponadeCardiac TamponadeTraumatic Aortic Traumatic Aortic RuptureRuptureTraumatic Asphy#iaTraumatic Asphy#iaDiaphragmatic Diaphragmatic RuptureRuptureSimp&e%C&osed 'neumothora#Simp&e%C&osed 'neumothora#pening in &ung tissue pening in &ung tissue that &ea)s air into chest that &ea)s air into chest cavitycavity*&unt trauma is main *&unt trauma is main causecause$ay !e spontaneous$ay !e spontaneous+sua&&y se&f correcting+sua&&y se&f correctingS%S of Simp&e%C&osed S%S of Simp&e%C&osed 'neumothora#'neumothora#Chest 'ainChest 'ainDyspneaDyspneaTachypneaTachypneaDecreased *reath Sounds on Affected SideDecreased *reath Sounds on Affected SideTreatment for Simp&e%C&osed Treatment for Simp&e%C&osed 'neumothora#'neumothora#A*C,s -ith C-spine contro&A*C,s -ith C-spine contro&Air-ay Assistance as neededAir-ay Assistance as neededIf not contraindicated transport in semi-If not contraindicated transport in semi-sitting positionsitting position'rovide supportive care'rovide supportive careContact .ospita& and%or A/S unit as soon as Contact .ospita& and%or A/S unit as soon as possi!&epossi!&e*/S '&us Care*/S '&us CareCardiac $onitorCardiac $onitorI0 access and Dra- *&ood Samp&esI0 access and Dra- *&ood Samp&es'rovide Air-ay $anagement -hich 'rovide Air-ay $anagement -hich inc&udes possi!&e Intu!ationinc&udes possi!&e Intu!ation$onitor for Deve&opment of Tension $onitor for Deve&opment of Tension 'neumothora#'neumothora#pen 'neumothora#pen 'neumothora#pening in chest pening in chest cavity that a&&o-s air cavity that a&&o-s air to enter p&eura& cavityto enter p&eura& cavityCauses the &ung to Causes the &ung to co&&apse due to co&&apse due to increased pressure in increased pressure in p&eura& cavityp&eura& cavityCan !e &ife threatening Can !e &ife threatening and can deteriorate and can deteriorate rapid&yrapid&ypen 'neumothora#pen 'neumothora#pen 'neumothora#pen 'neumothora#Inhalepen 'neumothora#pen 'neumothora#Ehalepen 'neumothora#pen 'neumothora#Inhalepen 'neumothora#pen 'neumothora#Ehalepen 'neumothoar#pen 'neumothoar#Inhalepen 'nuemothora#pen 'nuemothora#InhaleS%S of pen 'neumothora#S%S of pen 'neumothora#DyspneaDyspneaSudden sharp painSudden sharp painSu!cutaneous 1mphysemaSu!cutaneous 1mphysemaDecreased &ung sounds on affected sideDecreased &ung sounds on affected sideRed *u!!&es on 1#ha&ation from -ound Red *u!!&es on 1#ha&ation from -ound 2 a.).a. Suc)ing chest -ound32 a.).a. Suc)ing chest -ound3Su!cutaneous 1mphysemaSu!cutaneous 1mphysemaAir co&&ects in su!cutaneous fat from Air co&&ects in su!cutaneous fat from pressure of air in p&eura& cavitypressure of air in p&eura& cavity(ee&s &i)e rice crispies or !u!!&e -rap(ee&s &i)e rice crispies or !u!!&e -rapCan !e seen from nec) to groin area Can !e seen from nec) to groin area Suc)ing Chest 4oundSuc)ing Chest 4oundTreatment for pen Treatment for pen 'neumothora#'neumothora#A*C,s -ith c-spine contro& as indicatedA*C,s -ith c-spine contro& as indicated.igh (&o- o#ygen .igh (&o- o#ygen /isten for decreased !reath sounds on /isten for decreased !reath sounds on affected sideaffected sideApp&y occ&usive dressing to -oundApp&y occ&usive dressing to -oundNotify .ospita& and A/S unit as soon as Notify .ospita& and A/S unit as soon as possi!&epossi!&ecc&usive Dressingcc&usive Dressingcc&usive Dressingcc&usive DressingAsherman Chest Sea&Asherman Chest Sea&*/S '&us Care*/S '&us Care$onitor .eart Rhythm$onitor .eart Rhythm1sta!&ish I0 Access and Dra- *&ood 1sta!&ish I0 Access and Dra- *&ood Samp&esSamp&esAir-ay Contro& that may inc&ude Intu!ationAir-ay Contro& that may inc&ude Intu!ation$onitor for Tension 'neumothora#$onitor for Tension 'neumothora#Tension 'neumothora#Tension 'neumothora#Air !ui&ds in p&eura& space -ith no -here Air !ui&ds in p&eura& space -ith no -here for the air to escapefor the air to escapeResu&ts in co&&apse of &ung on affected side Resu&ts in co&&apse of &ung on affected side that resu&ts in pressure on mediastium5the that resu&ts in pressure on mediastium5the other &ung5 and great vesse&sother &ung5 and great vesse&sTension 'neumothora#Tension 'neumothora#1ach time -e inha&e5the &ung co&&apses further. Thereis no p&ace for the air toescape..Tension 'neumothora#Tension 'neumothora#1ach time -e inha&e5the &ung co&&apses further. Thereis no p&ace for the air toescape..Tension 'neumothora#Tension 'neumothora#.eart is !eingcompressedThe trachea ispushed tothe good sideS%S of Tension 'neumothora#S%S of Tension 'neumothora#An#iety%Rest&essnessAn#iety%Rest&essnessSevere DyspneaSevere DyspneaA!sent *reath sounds A!sent *reath sounds on affected sideon affected sideTachypneaTachypneaTachycardiaTachycardia'oor Co&or'oor Co&orAccessory $usc&e +seAccessory $usc&e +se60D60DNarro-ing 'u&se Narro-ing 'u&se 'ressures'ressures.ypotension.ypotensionTrachea& DeviationTrachea& Deviation2&ate if seen at a&&32&ate if seen at a&&3Treatment of Tension Treatment of Tension 'neumothora#'neumothora#A*C,s -ith c-spine as indicatedA*C,s -ith c-spine as indicated.igh (&o- o#ygen inc&uding *0$.igh (&o- o#ygen inc&uding *0$Treat for S%S of Shoc)Treat for S%S of Shoc)Notify .ospita& and A/S unit as soon as Notify .ospita& and A/S unit as soon as possi!&epossi!&eIf pen 'neumothora# and occ&usive If pen 'neumothora# and occ&usive dressing present *+R' occ&usive dressingdressing present *+R' occ&usive dressing*/S '&us Care*/S '&us Care$onitor Cardiac Rhythm$onitor Cardiac Rhythm1sta!&ish I0 access and Dra- *&ood 1sta!&ish I0 access and Dra- *&ood Samp&esSamp&esAir-ay contro& inc&uding Intu!ationAir-ay contro& inc&uding Intu!ationNeed&e Decompression of Affected SideNeed&e Decompression of Affected SideNeed&e DecompressionNeed&e Decompression/ocate 7-8 Intercosta& space midc&avicu&ar &ine/ocate 7-8 Intercosta& space midc&avicu&ar &ineC&eanse area using aseptic techni9ueC&eanse area using aseptic techni9ueInsert catheter 2 :;g or &arger3 at &east 8< in &ength Insert catheter 2 :;g or &arger3 at &east 8< in &ength over the top of the 8over the top of the 8rd rd ri!2 nerve5 artery5 vein &ie ri!2 nerve5 artery5 vein &ie a&ong !ottom of ri!3a&ong !ottom of ri!3Remove Sty&ette and &isten for rush of airRemove Sty&ette and &isten for rush of air'&ace (&utter va&ve over catheter'&ace (&utter va&ve over catheterReassess for ImprovementReassess for ImprovementNeed&e DecompressionNeed&e Decompression(&utter 0a&ve(&utter 0a&veAsherman Chest Sea& Asherman Chest Sea& ma)es good (&utter ma)es good (&utter 0a&ve .0a&ve .A&so can use a (inger A&so can use a (inger from a /ate# =&ove from a /ate# =&ove r A Condom -or)s r A Condom -or)s a&soa&so.emothora#.emothora#ccurs -hen p&eura& space fi&&s -ith !&oodccurs -hen p&eura& space fi&&s -ith !&ood+sua&&y occurs due to &acerated !&ood +sua&&y occurs due to &acerated !&ood vesse& in thora#vesse& in thora#As !&ood increases5 it puts pressure on heart As !&ood increases5 it puts pressure on heart and other vesse&s in chest cavityand other vesse&s in chest cavity1ach /ung can ho&d :.> &iters of !&ood1ach /ung can ho&d :.> &iters of !&ood.emothora#.emothora#.emothora#.emothora#.emothora#.emothora#.emothora#.emothora#.emothora#.emothora#.emothora#.emothora#$ay put pressure on the heart.emothora#.emothora#Lots of !lood "essels#here does the !lood come from$S%S of .emothora#S%S of .emothora#An#iety%Rest&essnessAn#iety%Rest&essnessTachypneaTachypneaSigns of Shoc)Signs of Shoc)(rothy5 *&oody Sputum(rothy5 *&oody SputumDiminished *reath Sounds on Affected SideDiminished *reath Sounds on Affected SideTachycardiaTachycardiaFlat Neck VeinsFlat Neck VeinsTreatmentfor .emothora#Treatmentfor .emothora#A*C,s -ith c-spine contro& as indicatedA*C,s -ith c-spine contro& as indicatedSecure Air-ay assist venti&ation if necessary Secure Air-ay assist venti&ation if necessary =enera& Shoc) Care due to *&ood &oss=enera& Shoc) Care due to *&ood &ossConsider /eft /atera& Recum!ent position if not Consider /eft /atera& Recum!ent position if not contraindicatedcontraindicatedRAPID TRANSPORTRAPID TRANSPORTContact .ospita& and A/S +nit as soon as possi!&eContact .ospita& and A/S +nit as soon as possi!&e*/S '&us Care*/S '&us Care$onitor Cardiac Rhythm$onitor Cardiac Rhythm1sta!&ish /arge *ore I0 prefera!&y 7 and 1sta!&ish /arge *ore I0 prefera!&y 7 and dra- !&ood samp&esdra- !&ood samp&esAir-ay management to inc&ude Intu!ationAir-ay management to inc&ude Intu!ationRapid TransportRapid TransportIf Deve&opment of .emo%'neumothora# If Deve&opment of .emo%'neumothora# need&e decompression may !e indicatedneed&e decompression may !e indicated(&ai& Chest(&ai& ChestThe !rea%ing of & The !rea%ing of & or more ri!s in & or more ri!s in & or more placesor more places(&ai& Chest(&ai& ChestS%S of (&ai& ChestS%S of (&ai& ChestShortness of *reathShortness of *reath'arado#ica& $ovement'arado#ica& $ovement*ruising%S-e&&ing*ruising%S-e&&ingCrepitus2 =rinding of !one ends on Crepitus2 =rinding of !one ends on pa&pation3pa&pation3Flail Chest is a True EmergencyFlail Chest is a True EmergencyTreatment of (&ai& ChestTreatment of (&ai& ChestA*C,s -ith c-spine contro& as indicatedA*C,s -ith c-spine contro& as indicated.igh (&o- o#ygen that may inc&ude *0$.igh (&o- o#ygen that may inc&ude *0$$onitor 'atient for signs of 'neumothora# $onitor 'atient for signs of 'neumothora# or Tension 'neumothora#or Tension 'neumothora#+se =&oved hand as sp&int ti&& !u&)y +se =&oved hand as sp&int ti&& !u&)y dressing can !e put on patientdressing can !e put on patientContact hospita& and A/S +nit as soon as Contact hospita& and A/S +nit as soon as possi!&epossi!&e*u&)y Dressing for sp&int of (&ai& *u&)y Dressing for sp&int of (&ai& ChestChest+se Trauma !andage +se Trauma !andage and Triangu&ar and Triangu&ar *andages to sp&int *andages to sp&int ri!s.ri!s.Can a&so p&ace a !ag Can a&so p&ace a !ag of D>4 on area and of D>4 on area and tape do-n. 2The on&y tape do-n. 2The on&y good use of D>4 I good use of D>4 I can find3can find3*/S '&us Care*/S '&us Care$onitor Cardiac Rhythm$onitor Cardiac Rhythm1sta!&ish I0 access1sta!&ish I0 accessAir-ay management to inc&ude Intu!ationAir-ay management to inc&ude Intu!ation!serve for patient to deve&op 'neumothora# and !serve for patient to deve&op 'neumothora# and even -orse Tension 'neumothora#even -orse Tension 'neumothora#If Tension Deve&ops Need&e Decompress affected If Tension Deve&ops Need&e Decompress affected sidesideRapid Transport? Remem!er a True 1mergencyRapid Transport? Remem!er a True 1mergency'ericardia& Tamponade'ericardia& Tamponade*&ood and f&uids *&ood and f&uids &ea) into the &ea) into the pericardia& sac pericardia& sac -hich surrounds the -hich surrounds the heart.heart.As the pericardia& As the pericardia& sac fi&&s5 it causes sac fi&&s5 it causes the sac to e#pand the sac to e#pand unti& it cannot unti& it cannot e#pand anymoree#pand anymorepericardial sac'ericardia& Tamponade'ericardia& Tamponadence the pericardia& nce the pericardia& sac can,t e#pand sac can,t e#pand anymore5 the f&uid anymore5 the f&uid starts putting starts putting pressure on the heartpressure on the heartNo- the heart can,t No- the heart can,t fu&&y e#pand and fu&&y e#pand and can,t pump can,t pump effective&y. effective&y. 'ericardia& Tamponade'ericardia& Tamponade4ith poor pumping the 4ith poor pumping the !&ood pressure starts to !&ood pressure starts to drop.drop.The heart rate starts to The heart rate starts to increase to compensate increase to compensate !ut is una!&e!ut is una!&eThe patient,s &eve& of The patient,s &eve& of conscious drops5 and conscious drops5 and eventua&&y the patient eventua&&y the patient goes in cardiac arrestgoes in cardiac arrestS%S of 'ericardia& TamponadeS%S of 'ericardia& TamponadeDistended Nec) 0einsDistended Nec) 0einsIncreased .eart RateIncreased .eart RateRespiratory Rate increasesRespiratory Rate increases'oor s)in co&or'oor s)in co&orNarro-ing 'u&se 'ressuresNarro-ing 'u&se 'ressures.ypotension.ypotensionDeathDeathTreatment of 'ericardia& Treatment of 'ericardia& TamponadeTamponadeA*C,s -ith c-spine contro& as indicatedA*C,s -ith c-spine contro& as indicated.igh (&o- o#ygen -hich may inc&ude .igh (&o- o#ygen -hich may inc&ude *0$*0$Treat S%S of shoc)Treat S%S of shoc)Rapi TransportRapi TransportNotify .ospita& and A/S +nit as soon as Notify .ospita& and A/S +nit as soon as possi!&epossi!&e*/S '&us Care*/S '&us CareCardiac $onitorCardiac $onitor/arge *ore I0 access /arge *ore I0 access Rapid TransportRapid Transport4hat patient needs is pericardiocentesis5 4hat patient needs is pericardiocentesis5 A&though not accepted practice in @Y pre-A&though not accepted practice in @Y pre-hospita& setting2 e#ception is that the (&ight hospita& setting2 e#ception is that the (&ight nurse,s of STATCAR1 may perform this nurse,s of STATCAR1 may perform this procedure in @Y3procedure in @Y3'ericardiocentesis'ericardiocentesis+sing aseptic techni9ue5 Insert at &east 8< need&e +sing aseptic techni9ue5 Insert at &east 8< need&e at the ang&e of the Aiphoid Carti&age at the Bat the ang&e of the Aiphoid Carti&age at the Bth th ri!ri!Advance need&e at ;> degree to-ards the c&avic&e Advance need&e at ;> degree to-ards the c&avic&e -hi&e aspirating syringe ti&& !&ood return is seen-hi&e aspirating syringe ti&& !&ood return is seenContinue to Aspirate ti&& syringe is fu&& then Continue to Aspirate ti&& syringe is fu&& then discard !&ood and attempt again ti&& signs of no discard !&ood and attempt again ti&& signs of no more !&oodmore !&oodC&ose&y monitor patient due to sma&& a!out of C&ose&y monitor patient due to sma&& a!out of !&ood aspirated can cause a rapid change in !&ood !&ood aspirated can cause a rapid change in !&ood pressurepressure'ericardia& Tamponade'ericardia& TamponadeIs A Dire EmergencyIs A Dire EmergencyTraumatic Aortic RuptureTraumatic Aortic RuptureThe heart5 more or &ess5 "usthangs from the aortic arch$uch &i)e a !ig pendu&um. If enough motion is p&aced onthe heart 2i.e.. Dece&eration(rom a motor vehic&e accident5 stri)ing a tree -hi&e s)iing etc3 the heart may tear a-ay from the aorta.Traumatic Aortic RuptureTraumatic Aortic RuptureThe chances of surviva& arevery s&im and are !ased on thedegree of the tear.If there is "ust a sma&& tear thenthe patient may survive. If theaorta is comp&ete&y transectedthen the patient -i&& die instantaneous&yS%S f Traumatic Aortic RuptureS%S f Traumatic Aortic Rupture*urning or Tearing Sensation in chest or *urning or Tearing Sensation in chest or shou&der !&adesshou&der !&adesRapid&y dropping *&ood 'ressureRapid&y dropping *&ood 'ressure'u&se Rapid&y Increasing'u&se Rapid&y IncreasingDecreased or &oss of pu&se or !%p on &eft Decreased or &oss of pu&se or !%p on &eft side compared to right sideside compared to right sideRapid /oss of ConsciousnessRapid /oss of ConsciousnessTreatment of Traumatic Aortic Treatment of Traumatic Aortic RuptureRuptureA*C,s -ith c-spine contro& as indicatedA*C,s -ith c-spine contro& as indicated.igh (&o- o#ygen that may inc&ude *0$ .igh (&o- o#ygen that may inc&ude *0$ Treatment for Shoc)Treatment for Shoc)RAPID TRANSPORTRAPID TRANSPORTContact .ospita& and A/S +nit As soon as Contact .ospita& and A/S +nit As soon as possi!&epossi!&e*/S '&us Care*/S '&us Care$onitor Cardiac Rhythm$onitor Cardiac Rhythm/arge *ore I0 therapy pro!a!&y 7 and dra- /arge *ore I0 therapy pro!a!&y 7 and dra- !&ood samp&es!&ood samp&esAir-ay management that may inc&ude Air-ay management that may inc&ude Intu!ationIntu!ationRAPID TRANSPORTRAPID TRANSPORTW!" P!"#$N" N$$%& #& B'#(" W!" P!"#$N" N$$%& #& B'#(" )#("& !N% C*)% &"$$))#("& !N% C*)% &"$$)Traumatic Asphy#iaTraumatic Asphy#iaResu&ts from sudden compression in"ury to Resu&ts from sudden compression in"ury to chest cavitychest cavityCan cause massive rupture of 0esse&s and Can cause massive rupture of 0esse&s and organs of chest cavityorgans of chest cavity+&timate&y Death+&timate&y DeathS%S of Traumatic Asphy#iaS%S of Traumatic Asphy#iaSevere DyspneaSevere DyspneaDistended Nec) 0einsDistended Nec) 0eins*u&ging5 *&ood shot eyes*u&ging5 *&ood shot eyesS-o&&en Tounge -ith cyanotic &ipsS-o&&en Tounge -ith cyanotic &ipsReddish-purp&e disco&oration of face and Reddish-purp&e disco&oration of face and nec)nec)'etechiae'etechiaeTreatment for Traumatic Treatment for Traumatic Asphy#iaAsphy#iaA*C,s -ith c-spine contro& as indicatedA*C,s -ith c-spine contro& as indicated.igh (&o- o#ygen inc&uding use of *0$.igh (&o- o#ygen inc&uding use of *0$Treat for shoc)Treat for shoc)Care for associated in"uriesCare for associated in"uriesRapid TransportRapid TransportContact .ospita& and A/S +nit as soon as Contact .ospita& and A/S +nit as soon as possi!&epossi!&e*/S '&us Care*/S '&us CareCardiac $onitorCardiac $onitor1sta!&ish I0 Access and dra- !&ood 1sta!&ish I0 Access and dra- !&ood samp&essamp&esAir-ay contro& inc&uding Intu!ationAir-ay contro& inc&uding Intu!ationRapid transportRapid transportDiaphragmatic RuptureDiaphragmatic RuptureA tear in the Diaphragm that a&&o-s the A tear in the Diaphragm that a&&o-s the a!domina& organs enter the chest cavitya!domina& organs enter the chest cavity$ore common on /eft side due to &iver $ore common on /eft side due to &iver he&ps protect the right side of diaphragm he&ps protect the right side of diaphragm Associated -ith mu&tipi&e in"ury patientsAssociated -ith mu&tipi&e in"ury patientsDiaphragm Rupture Diaphragm Rupture S%S of Diaphragmatic RuptureS%S of Diaphragmatic RuptureA!domina& 'ainA!domina& 'ainShortness of AirShortness of AirDecreased *reath Sounds on side of ruptureDecreased *reath Sounds on side of rupture*o-e& Sounds heard in chest cavity*o-e& Sounds heard in chest cavityTreatment of Diaphragmatic Treatment of Diaphragmatic RuptureRuptureA*C,s -ith c-spine contro& as indicatedA*C,s -ith c-spine contro& as indicated.igh (&o- o#ygen -hich may inc&ude .igh (&o- o#ygen -hich may inc&ude *0$*0$Treat Associated In"uriesTreat Associated In"uriesRapid TransportRapid TransportContact .ospita& and A/S +nit as soon as Contact .ospita& and A/S +nit as soon as possi!&epossi!&e*/S '&us Care*/S '&us CareCardiac $onitor Cardiac $onitor 1sta!&ish I0 access and dra- !&ood samp&es1sta!&ish I0 access and dra- !&ood samp&esAir-ay management inc&uding Intu!ationAir-ay management inc&uding Intu!ation!serve for 'neumothora# due to compression on !serve for 'neumothora# due to compression on &ung !y a!domina& contents&ung !y a!domina& contents'ossi!&e insertion of N= tu!e to he&p decompress 'ossi!&e insertion of N= tu!e to he&p decompress the stomach to re&ieve pressurethe stomach to re&ieve pressureRapid transport5 'atient needs *RI=.T /I=.TS Rapid transport5 'atient needs *RI=.T /I=.TS AND C/D ST11/AND C/D ST11/SummarySummaryChest In"uries are common and often &ife threatening Chest In"uries are common and often &ife threatening in trauma patients. So5 Rapid identification and in trauma patients. So5 Rapid identification and treatment of these patients is paramount to patient treatment of these patients is paramount to patient surviva&. Air-ay management is very important and surviva&. Air-ay management is very important and aggressive management is sometimes needed for aggressive management is sometimes needed for proper management of most chest in"uries.proper management of most chest in"uries.The 1NDThe 1NDCuestionsDCuestionsDCommentsCommentsCriticismsCriticismsSnide Remar)sSnide Remar)sIf not than) If not than) You You