06 thoracic trauma

8/19/2019 06 Thoracic Trauma

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THORACIC TRAUMATHORACIC TRAUMATHORACIC TRAUMATHORACIC TRAUMA


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OVERVIEWOVERVIEWOVERVIEWOVERVIEW

• Review thoracic anatomyReview thoracic anatomy

• Review thoracic assessmentReview thoracic assessment

• Review pathophysiology andReview pathophysiology andmanagement o the !"eadlymanagement o the !"eadly"o#en$ thoracic in%&ries"o#en$ thoracic in%&ries


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THORACICTHORACIC

A'ATOM(A'ATOM(

THORACICTHORACIC

A'ATOM(A'ATOM(


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THORACICTHORACIC

A'ATOM(A'ATOM(

THORACICTHORACIC

A'ATOM(A'ATOM(


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A))E))ME'T* +I,E THREAT)A))E))ME'T* +I,E THREAT),OU'" I' THE -RIMAR( )URVE(,OU'" I' THE -RIMAR( )URVE(

A))E))ME'T* +I,E THREAT)A))E))ME'T* +I,E THREAT),OU'" I' THE -RIMAR( )URVE(,OU'" I' THE -RIMAR( )URVE(

• Airway o.str&ctionAirway o.str&ction

• Open pne&mothora/Open pne&mothora/

• Tension pne&mothora/Tension pne&mothora/

• Massive hemothora/Massive hemothora/

• ,lail chest,lail chest

• Cardiac tamponadeCardiac tamponade


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+I,E THREAT) THAT CA''OT 0E+I,E THREAT) THAT CA''OT 0E"IA1'O)E" I' THE ,IE+""IA1'O)E" I' THE ,IE+"

+I,E THREAT) THAT CA''OT 0E+I,E THREAT) THAT CA''OT 0E"IA1'O)E" I' THE ,IE+""IA1'O)E" I' THE ,IE+"

• -&lmonary cont&sion-&lmonary cont&sion

• Myocardial cont&sionMyocardial cont&sion

• 0ronchial disr&ption0ronchial disr&ption

• Esophageal in%&ryEsophageal in%&ry

• "iaphragmatic tear "iaphragmatic tear

• Thoracic aortic disr&ptionThoracic aortic disr&ption


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O-E'O-E'

-'EUMOTHORA2-'EUMOTHORA2

O-E'O-E'



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MA'A1EME'T O-E'MA'A1EME'T O-E'-'EUMOTHORA2-'EUMOTHORA2

MA'A1EME'T O-E'MA'A1EME'T O-E'-'EUMOTHORA2-'EUMOTHORA2

• Ens&re ade3&ate airwayEns&re ade3&ate airway

• 4556 o/ygen4556 o/ygen

•)eal open wo&nd)eal open wo&nd• +oad 7 1o+oad 7 1o

• IV access en ro&teIV access en ro&te

• 'otiy Medical "irection'otiy Medical "irection Courtesy of David Effron, M.D.


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)EA+I'1 THE O-E')EA+I'1 THE O-E'

WOU'"WOU'"


WOU'"WOU'"

Asherman chest seal is very eective


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WOU'"WOU'"


WOU'"WOU'"

(o& can &se impervio&s material taped on three sides


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TE')IO'TE')IO'


TE')IO'TE')IO'



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MA'A1EME'TMA'A1EME'TTE')IO' -'EUMOTHORA2TE')IO' -'EUMOTHORA2

MA'A1EME'TMA'A1EME'TTE')IO' -'EUMOTHORA2TE')IO' -'EUMOTHORA2



• 'eedle decompression i indicated'eedle decompression i indicated• +oad 7 1o+oad 7 1o


• 'otiy Medical "irection'otiy Medical "irection


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I'"ICATIO') TOI'"ICATIO') TO"ECOM-RE)) TE')IO'"ECOM-RE)) TE')IO'


I'"ICATIO') TOI'"ICATIO') TO"ECOM-RE)) TE')IO'"ECOM-RE)) TE')IO'


• The presence o tensionThe presence o tensionpne&mothora/ withpne&mothora/ with

decompensation as evidenced .ydecompensation as evidenced .ymore than onemore than one o the ollowing*o the ollowing*

– Respiratory distress and cyanosis

– Loss of radial pulse (late shock

– Decreasin! L"C


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MA))IVEMA))IVE

HEMOTHORA2HEMOTHORA2

MA))IVEMA))IVE

HEMOTHORA2HEMOTHORA2


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MA'A1EME'TMA'A1EME'TMA))IVE HEMOTHORA2MA))IVE HEMOTHORA2

MA'A1EME'TMA'A1EME'TMA))IVE HEMOTHORA2MA))IVE HEMOTHORA2



• +oad 7 1o+oad 7 1o• IV access en ro&teIV access en ro&te


• O.serve or development oO.serve or development otension hemopne&mothora/tension hemopne&mothora/


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,+AI+ CHE)T,+AI+ CHE)T,+AI+ CHE)T,+AI+ CHE)T


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MA'A1EME'TMA'A1EME'T,+AI+ CHE)T,+AI+ CHE)T

MA'A1EME'TMA'A1EME'T,+AI+ CHE)T,+AI+ CHE)T



• -ossi.le int&.ation-ossi.le int&.ation

• +oad 7 1o+oad 7 1o

• )ta.ili#e lail segment)ta.ili#e lail segment


• Monitor EC1Monitor EC1• 'otiy Medical "irection'otiy Medical "irection


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CAR"IACCAR"IAC

TAM-O'A"ETAM-O'A"E

CAR"IACCAR"IAC

TAM-O'A"ETAM-O'A"E


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MA'A1EME'TMA'A1EME'TCAR"IAC TAM-O'A"ECAR"IAC TAM-O'A"E

MA'A1EME'TMA'A1EME'TCAR"IAC TAM-O'A"ECAR"IAC TAM-O'A"E



• +oad 7 1o+oad 7 1o• IV access en ro&teIV access en ro&te

• Monitor EC1Monitor EC1



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MA'A1EME'TMA'A1EME'TIM-A+E" O08ECT)IM-A+E" O08ECT)

MA'A1EME'TMA'A1EME'TIM-A+E" O08ECT)IM-A+E" O08ECT)



• )ta.ili#e o.%ect)ta.ili#e o.%ect

– Do not re#ove$• +oad 7 1o+oad 7 1o


• Watch or developmentWatch or developmento tension pne&mothora/o tension pne&mothora/or hemothora/or hemothora/


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OTHER CHE)TOTHER CHE)T

I'8URIE)I'8URIE)


I'8URIE)I'8URIE)

• Tra&matic aortic tear Tra&matic aortic tear

– %uspect &ith hi!h'i#pact inuries

– )sually dead on'scene

• Myocardial cont&sionMyocardial cont&sion – Looks like cardiac ta#ponade

– *lunt anterior chest trau#a

– Monitor EC+

• Esophageal in%&riesEsophageal in%&ries


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I'8URIE)I'8URIE)


I'8URIE)I'8URIE)

• "iaphragmatic tear "iaphragmatic tear

– Difficult to dia!nosis even at the hospital

– May hear o&el sounds in chest

• -&lmonary cont&sion-&lmonary cont&sion

– Most co##on pul#onary inury

– *lunt chest trau#a

– Dyspnea and cyanosis


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)UMMAR()UMMAR()UMMAR()UMMAR(

• -roper assessment-roper assessment

– Most inuries found in *-L% ri#ary%urvey

• ,re3&ently re3&ire +oad 7 1o,re3&ently re3&ire +oad 7 1o

• Airway is always irst priorityAirway is always irst priority

• 1ive 4556 o/ygen1ive 4556 o/ygen

• ,re3&ent Ongoing E/ams,re3&ent Ongoing E/ams


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9UE)TIO'):9UE)TIO'):9UE)TIO'):9UE)TIO'):

06 thoracic trauma

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