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Chest Trauma

Objectives

1. Review the anatomy of the chest.

2. Discuss the mechanics of breathing.

3. Detail the assessment process.

4. Cover the management of blunt and penetrating chest injuries.

• Chest injuries are the second leading cause of

trauma deaths each year.

• Chest injuries often go unrecognized.

• Missed injuries result in inadequate ventilation,

hypoxia and hypercarbia.

• Our goal is to find these injuries early and treat

them aggressively.

Introduction

Anatomy

&

Physiology

Anatomy

• Major structures in the thorax:

– Trachea.

– Bronchi.

– Lobes of the lungs.

– Heart.

– Aorta.

– Vena cava

– Esophagus.

V.A.N.

Anatomy & Physiology

Physiology

During inhalation and exhalation, the diaphragm moves

allowing for the lungs to expand/contract

Chest Trauma

Mechanism of injury:

1. Penetrating.

2. Blunt

3. Blast

Evaluation

• General signs:

Mechanism of Injury / Scene-Story

Fracture / Bruise / Wound

Asymetric Movement

Bloody foam from mouth and / or wound

Respiratory distress

Evaluation

• Respiratory distress:

Dyspnea

Pleuritic Pain

General distress

Tachypnea

Cyanosis

Retraction on Intra-costal muscles

Fractured Rib

• One rib fracture -

• Main danger: Difficulty breathing due to pain. Emphasis:

• Ribs # 1,2- Severe trauma

• Ribs # 9-12- Suspect internal organ injury

• Treatment: Analgesics, evacuation + high dose O2

Multiple Rib Fractures • Multiple rib fracture

• Flail chest

Dislocated section from rib cage

Paradoxical breathing

Severe pain and notable breathing difficulty

Lung Contusion

Flail Chest

Treatment:

Positive pressure ventilations

High dose O2

Evacuation

Chest Injuries

Pneumothorax

Open Closed

Simple

Pneumothorax

Tension

Chest Injuries

Hemothorax

Open Sucking

Chest Wound

• Open: a penetrating injury that allows air

to go in and out - the pressure between the pleura membranes is damaged.

• Closed: accumulation of air in the chest

closed: open:

Pneumothoraxes

Signs and Symptoms

Open Pneumothorax

Open chest wound

Mechanism of injury

General signs of chest injury

Respiratory Distress

Decreased breath sounds

Open Pneumothorax

Treatment:

Seal wound/s*

(Asherman)

Oxygen

Artificial ventilation*

Monitor

Evacuation

Major danger of Open Sucking Chest Wound?

Tension Pneumothorax

Chest Injury

Tension Pneumothorax

• What’s wrong with this X-ray?

Tension Pneumothorax Specific signs & symptoms:

Extreme respiratory distress

Shock

Jugular Vein Distention

Tracheal Deviation (late sign)

Absent breath sounds on the affected

side

Hypotension

Subcutaneous empysema

Hemothorax

Dangers: Hypovolemic

Shock Respiratory failure

Treatment:

IV Fluids

Oxygen

Rapid evacuation

A build up of blood in the pleural cavity

Treatment for

Chest Trauma

Treatment - continued

S.S.S Evaluate Kinetic energy

A

B Expose chest

Evaluate breathing quality

Ventilate if needed

Seal wound

Oxygen

Do not seal

wound if

ventilation

is required

Treatment - continued C

Hemodynamic – evaluation

D

E Search for additional wounds, seal off

Scoop & Run

En Route

Vital signs Monitor victim’s breathing status

Oxygen If not enough- begin ventilations

IV fluids

If situation deteriorates, or before ventilations

Remove AIR SEAL!!!