Chest Trauma

Organs/Vessels

Thoracic cavity Ribs Diaphragm Mediastinum (trachea, vena cava, aorta,

esophagus, heart) Lungs

Chest Anatomy

Pleura

2 Layers Keep lungs expanded Visceral layer Parietal layer

Pleural space Small amount of fluid

Pericardial Cavity

Fibrous pericardium Epicardium Potential space - < 50 ml of fluid

Pericardial Membranes

Other Considerations

Liver and spleen located under lower ribsTrauma Below nipples – Assume abdominal injuries

Trauma Above nipples – Assume cervical spine injuryAlways consider spinal column trauma

GSW can damage both cavitiesChest and abdominal trauma victims get high flow oxygen

Other Considerations

Major chest and abdominal trauma regularly occur together

When you see one, look for the other I bet you will find it

Hypoxia Consideration(End Point) Airway obstruction inadequate oxygen delivery Hypovolemia from blood loss Ventilation/perfusion mismatch from lung injury Changes in pleural pressures Pump failure

Manage hypoxia!!Airway controlRapid

Transport

Trauma Injury Effects

Heart – Ineffective pumping, blood loss Major vessels – Immediate & severe

blood loss Lungs – Ineffective ventilation Trachea - Obstruction Ribs – Ineffective chest expansion Diaphragm – Ineffective contraction

Deadly Dozen

Airway obstruction Open pneumothorax Tension pneumothorax Massive hemothorax Flail chest Cardiac tamponade

Traumatic aortic rupture

Tracheal/bronchial tree injury

Myocardial contusion Diaphragmatic tears Esophageal injury Pulmonary contusion

CLOSED CHEST INJURY

Closed (Blunt) – Falls, automobile crashes, direct blows to the chest Force distributed over large area

OPEN CHEST INJURY

Open (Penetrating) – Knife, GSW, ice picks, broken glass, nails Force distributed

over a small area

Blunt Trauma

Penetrating Trauma

Pneumothorax

Blunt or penetrating trauma Chest wall penetrated and air flows into the

thoracic cavity around the lungs Visceral and parietal pleura – air in pleural

space collapses the lung No penetration possible (broken rib), lung

laceration - most common

Pneumothorax

Pneumothorax S/S

Pneumothorax RX

Oxygen Reassessment (tension pneumothorax

possible) Transport

Sucking Chest Wound

Penetrating trauma An open chest wound that sucks air into the

wound; a noticeable sucking sound may be heard. Additional air being sucked into cavity Trapped air

Cover with gloved hand, or occlusive dressing (tape 3 sides)

Life Threat

Sucking Chest Wound

Tension Pneumothorax

Blunt or penetrating When air builds up collapsing one or both

lungsCan compresses large vessels and heart

Tension Pneumothorax S/S

Tension Pneumothorax RX

High flow oxygen Reassessment Rapid transport Open sucking wound? Occlusive dressing –

3 sides taped

Rib Fractures

Pain Most commonly blunt trauma Most commonly injured Reduced chest excursion – limits ventilation Consider pulmonary and/or myocardial contusions Consider pneumo/hemothorax

Rib Fractures S/S

Dyspnea Shallow respirations Guarding (self splinting) Painful respirations Tender, unstable ribs

Rib Fractures RX

Oxygen Splint? Reassessment Transport

Flail Chest

Major force involved Two or more adjacent ribs are broken in two or more

places Unattached segment (flail segment) Paradoxical movement (opposite movement of the rest of

the chest) Consider underlying injuries Stabilize with hand initially, splint later Life Threat

Flail Segment S/S

Tenderness, unstable segment Dyspnea Shallow respirations Guarding (self splinting) Painful respirations Paradoxical movement Shock

Flail Segment R/X

Provide high flow oxygen Assist ventilations, if required Stabilize flail segment (hand then bulky

dressings) Reassessment – Consider underlying

injuries Rapid Transport

Hemothorax

Penetrating and blunt trauma Rapid accumulation of blood in the chest

(greater than 1500 ml) Chest cavity can hold entire blood content

Hemothorax S/S

Cyanosis Flat neck veins Respiratory distress Shock Cold clammy skin Breath sounds absent, hypo resonant

Hemothorax RX

High flow oxygen Ventilate, as needed Rapid assessment Reassessment Rapid Transport

Traumatic Asphyxia

Severe crush injury (blunt force) to the chest

Compression of the superior vena cava Petechiae present Cerebral edema Head and neck swelling (tongue and lips) Conjunctival hemorrhage

Traumatic Asphyxia S/S

Swollen tongue, lips Bloodshot eyes Protruding eyes Chest trauma (blunt force)

Traumatic Asphyxia RX

CPR CABC High flow oxygen Ventilate Rapid transport

Pericardial Tamponade

Penetrating trauma common Blood filling the pericardial sack 15 ml – 20 ml of fluid removal may be life

saving

Pericardial Tamponade S/S

Beck’s Triad Distended neck veins Muffled heart sounds Hypotension

Tachycardia Narrowed pulse pressure Trachea midline Normal breath sounds

Pericardial Tamponade RX

High flow oxygen Ventilate, as needed Rapid transport Reassessment

Impaled Object in the Chest

Stabilize with dressings, build up around object Do not remove

Relevant Chest TraumaSAMPLE History GSW

Caliber, distance, number of shots, angle Stab Wounds

Length of blade, type of blade (smooth/serrated), sex of the stabber

FallsHeight, surface landed on, body part

landed on

Assessment TechniquesPage 954 & 956

Inspection (observation) – DCAP BTLS Palpation (touch) – Instability Percussion (sound waves) – Striking an

object and listening to the sound made Auscultation (listening) – Stethoscope;

breath sounds, heart tones

Palpation

Auscultation

Assessment Techniques

Vital signsBPPulseRespirationsBody Temperature

MOI Considerations

Page 217– “Scene Size- up” section Automobile crash – steering wheel Sports accident Fall GSW Fight Crush injury Explosion

Load-N-GoChest Injuries

Pneumothorax (tension too) Flail chest Hemothorax Sucking chest wound Traumatic asphyxia Pericardial tamponade

Terms

Paradoxical respirations

Asymmetrical chest wall movement that lessens respiratory efficiency

Terms

Hemoptysis

Coughing up blood

Terms

Occlusive Dressing

A dressing that can form an airtight seal over a wound

Terms

Decreased Pulse Pressure

The difference between the systolic and diastolic blood pressures. Narrowing seen with pericardial tamponade.

Terms

Subcutaneous Emphysema

Presence of air in the subcutaneous tissue; the resulting crackling sensation or sound

Tension Pneumothorax page 945

Build up of air and pressure in the thoracic cavity of the injured lung is so severe that it places pressure on the uninjured lung.

Results in compression of the heart, large vessels, and the uninjured lung.

TRUE EMERGENCY

BAD STUFF

BAD STUFF

QUESTIONS ?