Chest TraumaAcute Abdomen

1
Chest Trauma/Acute Abdomen
2
Chest Trauma

• Penetrating chest trauma
• Stab wounds and low velocity gun shot wounds
• Cause hemopneumothorax
• Manage with chest tubes
• Cardiac tamponade, mediastinal stab, and large
  blood losses require thoracotomy
• High velocity gun shot wounds
• Cause extensive injury/cavitation
• Hemorrhage, air leaks, and air embolism common

3
Chest Trauma

• Blunt chest trauma
• Rib fractures
• Damage underlying structures
• Cause severe pain with splinting, atelectasis,
  and hypoventilation
• More common as you get older because the chest is
  less flexible
• Treat with chest drainage, CPT, analgesics
• Increased intrathoracic pressure
• Abrupt increase in intrathoracic pressure may
  rupture the esophagus, alveoli, and diaphragm
• Cause mediastinitis, pneumothorax, and herniation
  of abdominal contents
• Shear stress
• Organ movement pulls on tissue which is tethered
• Can cause tears, aortic rupture, hematoma

4
Chest Trauma

• Tracheobronchial tears
• Suspect when the 1st and 2nd rib are fx with
  pneumothoraces
• Spiral tears in the mainstem bronchi are the most
  common, but the trachea can tear longitudinally
  along the posterior wall
• Lung injuries
• Pneumothorax/hemothorax
• Pulmonary contusion bleeding and edema
• Flail chest
• Multiple fx result in a free segment of chest
  wall/sternum
• Paradoxical movement with normal breathing causes
  hypoventilation
• Discomfort also limits Vt and cough

5
Chest Trauma

• Diaphragmatic injuries
• Usually happens on the left b/c right diaphragm
  is protected by the liver
• High mortality because of associated spleen and
  liver rupture
• Heart/Great Vessel injuries
• Cardiac contusion
• Causes edema and microvascular hemorrhage at the
  site of impactresults in ischemia, arrhythmias,
  heart block, ventricular failure

6
Chest Trauma

• Heart/great vessel injuries
• Aortic tears/dissection
• Due to shearing from abrupt deceleration
• Most are fatal
• Pericardial tamponade
• Aortic root disruption, coronary artery
  laceration, or rupture of the ventricular wall
• Requires surgery or drainage
• Traumatic damage
• May involve the heart, valves (usually aortic),
  papillary muscles, or pericardium
• Rupture of the ventricular wall is rapidly fatal

7
Chest Trauma

• Esophageal rupture
• Suspect if major trauma associated with rapidly
  developing pleural effusion or pneumothorax
• Prognosis is poor
• Fat embolism
• Occurs 1-3 days after multiple long bone or
  pelvic fx
• Liberated fat/fatty acids lead to emboli