Hassan JamilFinal yearRoll no. 104Batch D

Chest trauma

Chest trauma

• 70 % deaths in road traffic accidents are due to thoracic trauma

• Traumas can be penetrating or blunt

Types

• Immediate life threatening injuries

• Potentially life threatening injuries

Immediate life threatening injuries

• Airway obstruction• Tension pneumothorax• Hemothorax• Cardiac temponade• Flial chest

Airway obstruction Any entity that causes disruption in the normal flow of air

Leads to• Hypoxia• Hypercapni

a

Management

• Mechanical removal of obstruction

• Endotracheal intubation

Tension Pneumothorax

• Air in the pleural space that is under high pressure

• One way valve injury• Due to lung parenchymal or

bronchial injury• External Trauma • Displaces mediastinal structures

Causes • Lung collapse• Hypoxia• Decreased venous return• Impaired cardiac function• Decreased cardiac output• Hypotension• Death

Life threatening condition

Physical examination

• Respiratory distress• Cyanosis• Decreased or absent lung

sounds• Hyperresonance on

percussion• Hypotension

Chest wall trauma

Trauma of the bronchial tree

Treatment

Thoracocentesis (insertion of a wide bore needle)

Followed by chest intubation

Point to remember

• Donot wait for x-ray to make diagnosis of tension pneumothorax

Hemothorax

• Presence of blood in the pleural space

• Caused due to trauma leading to injury of internal mammary or intercostal artery

Signs

• Reduced chest expansion• Dull percussion note• Absent breath sounds

Treatment

• Intercostal chest tube insertion attached to an underwater seal

• Thoracotomy in case of massive hemothorax

Cardiac tamponade

• Accumulation of blood in the pericardial sac

• Causes compression of the cardiac chamber

• Decreased cardiac filling, decreased cardiac output

• Patient presents with hypotension and distended neck veins

Treatment

• Pericardiocentesis• Thoracotomy

Flial chest

• Multiple rib fractures which produce a mobile fragment

• This fragment moves paradoxically with respiration

• Causes lung compression

Treatment

If the fragment is small and not interfering with respiration then patient is administered good analgesic until segment stabilizes

Potential life threatening injuries

• Tracheobronchial disruption• Aortic disruption• Diaphragmatic disruption• Pulmonary contusion

Tracheobronchial disruption

• Disruption at the junction of trachea and the main broncus

• In the region of the carnia• Causes collapsed lung and

massive air leak resulting in subcutaneous emphysema

Aortic disruption

• Caused due to deceleration injury

• Explain mechanism with diagram

• Tear in the aorta• Shock, deviation of the

visceras

Diaphragmatic disruption

• Trauma to the chest and abdomen causing tear in the diaphragm

• Diagnosis by chest radiograph showing stomach or colon in the chest

Pulmonary contusion

• Occurs in 30-75% of all the patients with major chest injury

• Caused by blunt trauma• Produces capillary disruption-intra

alveolar hemorrhage-edema-small airway obstruction

• Chest radiograph shows arterial blood gas analysis

• Treatment : fluid resuscitation, chest physiotherapy, analgesics

Other conditions• First rib fracture• Multiple rib fractures• Stove in chest• Cervical rib

Thankyou