Thoracic Trauma

1
Thoracic Trauma
Chapter 24
2
Chest Injuries

• Incidence
• Classifications
• Skeletal injury
• Pulmonary injury
• Heart and great vessel injury
• Diaphragmatic injury

3
Mechanism of Injury

• Blunt thoracic injuries
• Forces distributed over a large area
• Penetrating thoracic injuries
• Forces distributed over a small area
• Organs injured are usually those that lie along
  the path of the penetrating object

4
The Thorax

• Skin
• Bones
• Thoracic cage
• Sternum
• Thoracic spine
• Muscles

5
Anatomy

• Lungs
• Parenchyma
• Alveoli
• Alveolar-capillary interface
• Pleura
• Visceral
• Parietal
• Serous fluid
• Lobes

6
Vessels

• Arteries
• Aorta
• Carotid
• Subclavian
• Intercostal
• Innominate
• Internal mammary
• Pulmonary

• Veins
• Superior vena cava
• Inferior vena cava
• Subclavian
• Internal jugular
• Pulmonary

7
Anatomy

• Heart
• Esophagus
• Thoracic inlet
• Esophageal foramen through diaphragm
• Mediastinum

8
Ventilation

• Mechanical process of moving air into and out of
  the lungs
• Bellows system
• Musculoskeletal structure
• Intercostal muscles
• Diaphragm
• Accessory muscles
• Changes in intrathoracic pressure

9
Respiration

• Exchange of oxygen and carbon dioxide between the
  outside atmosphere and the cells of the body
• Neurochemical control
• Gas exchange
• Alveolar-capillary interface
• Capillary-cellular interface
• Pulmonary circulation
• Cardiac circulation

10
Clavicular Fractures

• Incidence
• Morbidity and mortality
• Pathophysiology
• Assessment findings
• Management

Fracture of the left clavicle seen from above the
left shoulder.
11
Rib Fractures

• Incidence
• Morbidity/mortality
• Pathophysiology
• Associated complications
• Assessment findings
• Management

Chest wall asymmetry caused by rib fractures
12
Flail Chest

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

13
Normal Lungs
14
Flail Chest During Inspiration
15
Flail Chest During Expiration
16
Sternal Fractures

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

Spotty bruising caused by a steering wheel impact.
17
Closed (Simple) Pneumothorax

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

18
Open Pneumothorax ("Sucking Chest Wound")

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

19
Open Pneumothorax

• Air enters pleural cavity during inspiration
• Air exits pleural cavity during expiration

20
Open Pneumothorax

• Sealing a chest wound

21
Tension Pneumothorax

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

22
Tension Pneumothorax

• May occur when an open pneumothorax has been
  sealed with an occlusive dressing
• Pressure may be relieved by momentarily removing
  the dressing
• Air escapes with an audible release of air
• After release of pressure, wound should be
  resealed

23
Tension Pneumothorax

• Must be relieved through thoracic decompression
  with
• Large-bore needle or
• Commercially available thoracic decompression kit

24
Needle Decompression

• Insert hollow needle or catheter into affected
  pleural space
• After needle insertion, note audible rush of air
  as pressure escapes

25
Needle Decompression

• Secure the catheter and prevent the reentry of
  air into the pleural space

26
Hemothorax

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

27
Hemopneumothorax

• Pathophysiology
• Pneumothorax with bleeding in pleural space
• Assessment
• Findings same as hemothorax
• Management
• Same as a hemothorax

28
Pulmonary Contusion

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

29
Traumatic Asphyxia

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

30
Myocardial Contusion (Blunt Myocardial Injury)

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

31
Pericardial Tamponade

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

32
Myocardial Rupture

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

33
Traumatic Aortic Rupture

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

34
Diaphragmatic Rupture

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

35
Esophageal Injury

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management

36
Tracheobronchial Injuries

• Incidence
• Morbidity/mortality
• Pathophysiology
• Assessment findings
• Management