THORACIC TRAUMABy

Dr.Saleh Bakar

YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!

INTRODUCTION• Each year there are nearly 150,000

accidental deaths in the United States

• 25% of these deaths are a direct result of thoracic trauma

• An additional 25% of traumatic deaths have chest injury as a contributing factor

MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS

0102030405060708090

100

Total Wounded

79% 63% 56% 25% 12%

% Chest Wound Related Deaths

Crimean War (1853-1856)

American Civil War(1861-1865)

Franco-PrussianWar (1870-1871)

World War I (1914-1918)

World War II (1939-1945)

REASON

As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!

Major Anatomy and Physiology of the Chest

OVERVIEW

• Causes of Thoracic Trauma

• Types, Signs and Symptoms, and Management of Thoracic Trauma

CAUSES OF THORACIC TRAUMA:

• Falls3 times the height of the patient

• Blast Injuriesoverpressure, plasma forced into alveoli

• Blunt Trauma • PENETRATING TRAUMA

OPEN PNEUMOTHORAX• Develops when penetration injury to the chest

allows the pleural space to be exposed to atmospheric pressure - “Sucking Chest Wound”

• Q- WHAT MAY CAUSE A SCW?

• Examples Include:­ GSW, Stab Wounds, Impaled Objects, Etc...

LARGE VS SMALL

• Severity is directly proportional to the size of the wound

• Atmospheric pressure forces air through the wound upon inspiration

S/S: OPEN PNEUMOTHORAX

• Shortness of Breath (SOB)

• Pain

• Sucking or gurgling sound as air moves in and out of the pleural space through the wound

MANAGEMENT OF SCW

• Apply an Asherman Chest Seal Occlusive dressing with a release valve

• Observe for development of a

Tension Pneumothorax

TENSION PNEUMOTHORAX

• Air within thoracic cavity that cannot exit the pleural space

• Fatal if not immediately identified, treated, and reassessed for effective management

Tension Pneumothorax Following Stab Wound

EARLY S/S OF TENSION PNEUMOTHORAX

• ANXIETY!

• Increased respiratory distress

• Unilateral chest movement

• Unilateral decreased or absent breath sounds

LATE S/S OF TENSION PNEUMOTHORAX

• Jugular Venous Distension (JVD)

• Tracheal Deviation

• Narrowing pulse pressure

• Signs of decompensating shock

JVD & TRACHEAL SHIFT

Decreased input and output from the heart with compression of the great vessels

JVD & TRACHEAL SHIFT

Increased pressure moves mediastinum and compresses the lung on the uninjured side

MANAGEMENT OF TENSION PNEUMOTHORAX

• Asherman Chest Seal

• Needle Decompression

• High flow oxygen (If available)

• Bag Valve Mask / Intubation

• Chest Tube (BN CCP/CASEVAC)

RGR MEDICCHEST TUBE INSERTION

NEEDLE THORACENTESIS• Locate 2nd or 3rd Intercostal Space at the Midclavicular Line

• Insert a 14g needle/catheter over the top of the rib (“VAN”) into the pleural space

• Listen for air escape (WHOOSH!)

• Leave the catheter in place

• Reassess

NEEDLE THORACENTESIS

NEEDLE THORACENTESIS

SUMMARY

• Reviewed anatomy and physiology of the chest• Discussed causes of trauma to the chest• Signs, symptoms, and emergent management of:

OPEN PNEUMOTHORAX

Asherman Chest Seal

TENSION PNEUMOTHORAX

Needle Thoracentesis

QUESTIONS?