Thoracic Trauma

Hossam Hassan

Thoracic Trauma Anatomy Thorax is a hollow cylinder composed of 12 pairs of ribs10articulate posteriorly with

the thoracic spine and anteriorly with the sternum via costal cartilagesthe lower 2 pairs are floating ribs

A nervean artery and a vein are located a long the under side of each rib

Intercostals muscles connect each rib to the one above these muscles with the diaphragm are the primary muscle of ventilation

Anatomy The pleurae are thin membranes

that consist of 2 distinct layers The partial pleurae line the inner

side of the thoracic cavity The visceral pleurae cover the

outer surface of each lung

Anatomy The lungs occupy the right and the left

halves of the thoracic cavity An area called the mediastinum is located

in the middle of the thoracic cavity within the mediastinum lie all the other organs and structures of the chest cavitythe heartgreat vesselstracheamainstem bronchi and esophagus

Any or all of these structures can be injured by thoracic trauma

General Assessment The signs and symptoms of chest truma

related to the chest wall and lungs are sobtachypnea and chest pain

The initial 3 points in general assessment is

1Observation exbruiseslacerationsdistended neck veins

2Palpation extendernessbony crepitus3Auscultation expresence diminished or

absence of breath sounds

Thoracic injuries can be Rib Fractures Flail chest Pulmonary contusion Pneumothorax(open and close) Tension pneumothorx Hemothorax Blunt cardiac injuries Pericardial tamponade Tracheal and bronchial rupture Aortic rupture Diaphragmatic rupture

Chest Trauma History amp PE ATLS protocol ABCDErsquos

Contusions diminished or absent breath sounds SQ emphysema

AMPLE A allergies M Medications (Anticoagulants

insulin and cardiovascular medications especially)

Previous medicalsurgical history L Last meal (Time) E Events Environment surrounding

the injury ie Exactly what happened

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Thoracic Trauma Anatomy Thorax is a hollow cylinder composed of 12 pairs of ribs10articulate posteriorly with

the thoracic spine and anteriorly with the sternum via costal cartilagesthe lower 2 pairs are floating ribs

A nervean artery and a vein are located a long the under side of each rib

Intercostals muscles connect each rib to the one above these muscles with the diaphragm are the primary muscle of ventilation

Anatomy The pleurae are thin membranes

that consist of 2 distinct layers The partial pleurae line the inner

side of the thoracic cavity The visceral pleurae cover the

outer surface of each lung

Anatomy The lungs occupy the right and the left

halves of the thoracic cavity An area called the mediastinum is located

in the middle of the thoracic cavity within the mediastinum lie all the other organs and structures of the chest cavitythe heartgreat vesselstracheamainstem bronchi and esophagus

Any or all of these structures can be injured by thoracic trauma

General Assessment The signs and symptoms of chest truma

related to the chest wall and lungs are sobtachypnea and chest pain

The initial 3 points in general assessment is

1Observation exbruiseslacerationsdistended neck veins

2Palpation extendernessbony crepitus3Auscultation expresence diminished or

absence of breath sounds

Thoracic injuries can be Rib Fractures Flail chest Pulmonary contusion Pneumothorax(open and close) Tension pneumothorx Hemothorax Blunt cardiac injuries Pericardial tamponade Tracheal and bronchial rupture Aortic rupture Diaphragmatic rupture

Chest Trauma History amp PE ATLS protocol ABCDErsquos

Contusions diminished or absent breath sounds SQ emphysema

AMPLE A allergies M Medications (Anticoagulants

insulin and cardiovascular medications especially)

Previous medicalsurgical history L Last meal (Time) E Events Environment surrounding

the injury ie Exactly what happened

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Anatomy The pleurae are thin membranes

that consist of 2 distinct layers The partial pleurae line the inner

side of the thoracic cavity The visceral pleurae cover the

outer surface of each lung

Anatomy The lungs occupy the right and the left

halves of the thoracic cavity An area called the mediastinum is located

in the middle of the thoracic cavity within the mediastinum lie all the other organs and structures of the chest cavitythe heartgreat vesselstracheamainstem bronchi and esophagus

Any or all of these structures can be injured by thoracic trauma

General Assessment The signs and symptoms of chest truma

related to the chest wall and lungs are sobtachypnea and chest pain

The initial 3 points in general assessment is

1Observation exbruiseslacerationsdistended neck veins

2Palpation extendernessbony crepitus3Auscultation expresence diminished or

absence of breath sounds

Thoracic injuries can be Rib Fractures Flail chest Pulmonary contusion Pneumothorax(open and close) Tension pneumothorx Hemothorax Blunt cardiac injuries Pericardial tamponade Tracheal and bronchial rupture Aortic rupture Diaphragmatic rupture

Chest Trauma History amp PE ATLS protocol ABCDErsquos

Contusions diminished or absent breath sounds SQ emphysema

AMPLE A allergies M Medications (Anticoagulants

insulin and cardiovascular medications especially)

Previous medicalsurgical history L Last meal (Time) E Events Environment surrounding

the injury ie Exactly what happened

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Anatomy The lungs occupy the right and the left

halves of the thoracic cavity An area called the mediastinum is located

in the middle of the thoracic cavity within the mediastinum lie all the other organs and structures of the chest cavitythe heartgreat vesselstracheamainstem bronchi and esophagus

Any or all of these structures can be injured by thoracic trauma

General Assessment The signs and symptoms of chest truma

related to the chest wall and lungs are sobtachypnea and chest pain

The initial 3 points in general assessment is

1Observation exbruiseslacerationsdistended neck veins

2Palpation extendernessbony crepitus3Auscultation expresence diminished or

absence of breath sounds

Thoracic injuries can be Rib Fractures Flail chest Pulmonary contusion Pneumothorax(open and close) Tension pneumothorx Hemothorax Blunt cardiac injuries Pericardial tamponade Tracheal and bronchial rupture Aortic rupture Diaphragmatic rupture

Chest Trauma History amp PE ATLS protocol ABCDErsquos

Contusions diminished or absent breath sounds SQ emphysema

AMPLE A allergies M Medications (Anticoagulants

insulin and cardiovascular medications especially)

Previous medicalsurgical history L Last meal (Time) E Events Environment surrounding

the injury ie Exactly what happened

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

General Assessment The signs and symptoms of chest truma

related to the chest wall and lungs are sobtachypnea and chest pain

The initial 3 points in general assessment is

1Observation exbruiseslacerationsdistended neck veins

2Palpation extendernessbony crepitus3Auscultation expresence diminished or

absence of breath sounds

Thoracic injuries can be Rib Fractures Flail chest Pulmonary contusion Pneumothorax(open and close) Tension pneumothorx Hemothorax Blunt cardiac injuries Pericardial tamponade Tracheal and bronchial rupture Aortic rupture Diaphragmatic rupture

Chest Trauma History amp PE ATLS protocol ABCDErsquos

Contusions diminished or absent breath sounds SQ emphysema

AMPLE A allergies M Medications (Anticoagulants

insulin and cardiovascular medications especially)

Previous medicalsurgical history L Last meal (Time) E Events Environment surrounding

the injury ie Exactly what happened

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Thoracic injuries can be Rib Fractures Flail chest Pulmonary contusion Pneumothorax(open and close) Tension pneumothorx Hemothorax Blunt cardiac injuries Pericardial tamponade Tracheal and bronchial rupture Aortic rupture Diaphragmatic rupture

Chest Trauma History amp PE ATLS protocol ABCDErsquos

Contusions diminished or absent breath sounds SQ emphysema

AMPLE A allergies M Medications (Anticoagulants

insulin and cardiovascular medications especially)

Previous medicalsurgical history L Last meal (Time) E Events Environment surrounding

the injury ie Exactly what happened

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Chest Trauma History amp PE ATLS protocol ABCDErsquos

Contusions diminished or absent breath sounds SQ emphysema

AMPLE A allergies M Medications (Anticoagulants

insulin and cardiovascular medications especially)

Previous medicalsurgical history L Last meal (Time) E Events Environment surrounding

the injury ie Exactly what happened

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

AMPLE A allergies M Medications (Anticoagulants

insulin and cardiovascular medications especially)

Previous medicalsurgical history L Last meal (Time) E Events Environment surrounding

the injury ie Exactly what happened

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

CXR-fast easy least expensive for initial evaluation

Ultrasound-may soon replace CXR as initial radiographic study in chest trauma

CT Scan VS Angiography EChO VS Transesophogeal

Echocardiography

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

FAST

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Normal CXR

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Pneumothorax

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Subcutaneous Emphysema

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Hemothorax

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Management of specific injuries Rib fracture Assessment Simple rib fracture alone are rarely

life threatening in adults Signs and symptoms of fractured

ribs include pain with movementlocal tenderness and perhaps bony crepitus

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Rib fracture Management The initial management of patient with

simple rib fracture is pain reduction supplemental oxygen in case hypoxia Bed rest Fractured ribs should not be stabilized by

taping or using any other firm bandaging such attempt can limit ventilation and lead to atelactasis (collapse of the alveoli or part of the lung)and pneumonia

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Flail Chest Flail chest is when 2 or more

adjacent ribs are each fractured in at least 2 places

Assessment Tenderness Bony crepitus Hypoxia might happen then lead to

increase in respiratory rate as well

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Flail chest Management The key management is BVM (for

positive pressure ventilation) All patient who have an obvious

flail segment should supplied with supplemental O if not respond then will require more aggressive ventilataroy support

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Pulmonary contusion A pulmonary contusion is an area of the

lung that has been traumatized to the point where intertitial and leveolar bleeding occur

The amount of intertitial fluids increase in the area between the wall of the cappilaries and alveoli resulting in decreased O transporst across the thickened membranes

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Pulmonary contusion Managements Patient should closely monitored with

special attention to fluid administration

Ensuring adequate ventilation and enriched O administration

In inadequate ventilations or altered LOC or other major injuries BVM and endotracheal intubation if required

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Pneumothorax Simple pneumothorax Open pneumothorax

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Simple pneumothorax Simple pneumothorax is caused by

the presence of air in the pleural space

Assessment Pleuratic chest pain Difficult and rapid breathing Decreased or absent breath sounds

on the involved side are classic signs Percussion is an excellent indicator

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Simple pneumothorax Management High concentration of O should

be administrated to patients with pneumothorax

Assisted ventilation might be for those who display signs of hypoxia

Semi sitting position is preferred

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Open pneumothorax Penetrating wounds to the chest can

produce open chest wall injuries(open pneumothorax)

Assessment Pain at the injured side SOB The sings might included sucking out

bubbling sound as air moves in and out of the pleural space through the chest wall defected

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Open pneumothorax Management Close the hole in the chest Closing the hole it could be with a

Vaseline gauze by 3 sides taped Provide supplemental O If signs of increasing respiratory distress

are observed the patient may be developing a tension pneumothorax and the dressing should be removed to assess in decompressing the affected side

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Tension pneumothorax It is a life threatening situation The amount of air trapped in the pleural

space continues to increase not only is the lung on the affected side collapsed but the mediastinum is also shifted into the opposite side

The intra thoracic pressure increase witch decrease the capillaries blood flow and kinks the vena cava

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Tension pneumothorax Assessment The presentation of patient with tension

pneumothorax varies according to how much intrathoracic pressure has developed

Signs and symptoms can be minimal or moderate Anxiety Cyanosis Tachypnea Diminished or absent breath sound on the injured

side JVD (jugular vein distension)note in case

hypovolemic this sign might not present

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Tension pneumothorax Management The management of the patient with a

tension pneumothorax involves reducing the pressure in the pleural space

Needle decompression in the field can be done by the expert people

Chest tube Incase penetrating injury then dressing Refer to the specialist area as soon as

possible

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Hemothorax Blood in the pleural space

constitutes a hemothorax In adult the pleural space on each

side of the thorax can hold 2500 to 3000 ml of blood

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Hemothorax Assessment The symptoms are related to the blood loss Sings Sob Tachypnea Decreased breath sound Clinical signs of shock Management transfer to surgical repair

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Myocardial Contusion Occurs in 76 of patients with

severe blunt chest trauma ndashRight Atrium and Ventricle is

commonly injured ndashInjury may reduce strength of

cardiac contractions Reduced cardiac output

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Electrical Disturbances due to irritability of damaged myocardial cells

ndashProgressive Problems Hematoma Hemoperitoneum Myocardial necrosis Dysrhythmias CHF amp or Cardiogenic shock

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Myocardial Contusion Signs amp Symptoms Bruising of chest wall 1048708Tachycardia andor irregular

rhythm 1048708Retrosternal pain similar to MI 1048708Associated injuries Rib Sternal

fractures

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Chest pain unrelieved by oxygen May be relieved with rest THIS IS TRAUMA-RELATED PAIN

Similar signs and symptoms of medical chest pain

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Blunt Cardiac Injury EKG (for any blunt chest injury

persistent tachycardia ST-T changes or ectopy)

1048708Cardiac enzymes (CPK CK-MB and Troponin I)

1048708Echocardiography (TEE)

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Pericardial Tamponade Restriction to cardiac filling caused

by blood or other fluid within the pericardium

ndashOccurs in lt2 of all serious chest trauma However very high mortality

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

ndashResults from tear in the coronary artery or penetration of myocardium

Blood seeps into pericardium and is unable to escape

200 ml of blood can restrict effectiveness of cardiac contrac

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Pericardial Tamponade Signs amp Symptoms Dyspnea Possible cyanosis Beckrsquos Triad JVD Distant heart tones Hypotension or narrowing pulse pressure Weak thready pulse Shock

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Kussmaulrsquos signDecrease or absence of JVD during inspiration

Pulsus ParadoxusDrop in SBP gt10 during inspiration

Electrical AlteransP QRS amp T amplitude changes in every other cardiac cycle

PEA

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Traumatic Aortic injury

Aorta most commonly injured in severe blunt 85-95 mortality

Injury may be confined to areas of aorta attachment

Signs amp Symptoms Rapid and deterioration of vitals Pulse deficit between right and left upper

or lower extremities

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Traumatic Esophageal Rupture Rare complication of blunt thoracic trauma ndash30 mortality ndashContents in esophagusstomach may

move into mediastinum Serious infection occurs Chemical irritation Damage to mediastinal structures Air enters mediastinum

ndash

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Subcutaneous emphysema and penetrating trauma present

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Tracheo-bronchial Injury Blunt trauma Penetrating trauma 50 of patients with injury die within

1 hr of injury Disruption can occur anywhere in

tracheobronchial tree

ndash

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Signs amp SymptomsDyspnea Cyanosis Hemoptysis Massive subcutaneous emphysema Suspect evaluate for other closed

chest trauma

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Treatment summary Observe Palpate Auscultation Management always included to

provide supplemental O then aggressive method if required

ATLS protocol ABCDErsquos

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Treatment summary Emergency management Needle thoracentesis Tube thoracostomy Subxiphoid pericardotomy Video assisted thoracic surgery

(VATS)

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

THANK YOU

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

3 Identification of which of the following is NOT an essential part of the primary survey

A Tension Pneumothorax B Open Pneumothorax C Flail Chest D Cardiac Tamponade E Rib Fractures

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

4 Upon Identification of a Tension Pneumothorax which is the correct management pathway

A A chest X-ray to confirm the clinical diagnosis B Insertion of a chest drain in the 5th intercostals

interspace in mid-axillary line C Immediate decompression with a 14g 5cm needle in

the 2nd intercostal interspace in mid-calvicular line D An ECG to assess for concurrent cardiac contusion E Completion of a secondary survey to exclude any

concurrent injury

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

In massive haemothorax which of the following is an indication for emergency thoracotomy

A Production of 500ml of blood on immediate insertion of a

chest drain B Production of 50mlhour of blood for two consecutive

hours in the chest drain C Production 1000ml of blood on immediate insertion of a

chest drain D Production of greater than 1500ml of blood on

immediate insertion of a chest drain E Evidence of greater than 5 rib fractures in conjunction

with radiological evidence of haemothorax

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

A pulmonary contusion A Can cause immediate respiratory difficulties B Results in increased lung compliance at 24

hours C Does not occur without rib fractures in

children D Can cause ventilationperfusion mismatch

which evolves over 24 hours E Is not associated with Adult Respiratory

Distress Syndrome

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

When evaluating the chest of a patient with a chest injury you note a fine crackling sensation under the areas that you palpate This is best described as

pulses paradoxus subcutaneous emphysema hemothorax none of the above

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

In which condition would you observe paradoxical movement of the chest wall

mediastinal shift tension pneumothorax flail chest CheynendashStokes breathing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Proper care for a patient with a sucking chest wound includes

pulling the wound open on inhalation to release trapped air sealing the wound with an occlusive dressing covering the wound with sterile gauze decompression of the chest

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

Which of the following statements correctly differentiates a simple pneumothorax from a tension pneumothorax

A tension pneumothorax requires decompression while a simple pneumothorax does not A simple pneumothorax is caused by air in the pleural space while a tension pneumothorax is caused by blood in the pleural space A simple pneumothorax is caused by damage to the lung from inside while a tension pneumothorax is caused by injury to the outside chest wall There is no difference between a tension pneumothorax and simple pneumothorax

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing

After placing an occlusive dressing over a sucking chest wound to the right chest you note that the patient has become extremely dyspneic and cyanotic with breath sounds absent on the right side Your next action would be to

perform a needle cricothyroidotomy remove the occlusive dressing and replace it with sterile gauze insert an oropharyngeal airway loosen a corner of the occlusive dressing