???????????????????????????????? chest trauma

1
???????????????????????????????? chest trauma
?.????????? ???????????
2
????????????
?????????????? ?????? ???? ???????????????????????
???????????????????
??????????????????????????????????????????????????
?
??????????????????????????????????????????????????
?????????
??????????????????????????????????????????????????
??????????
????????????????????? ???????????????????????????
3
????????????????
??????????????????
????????????????????
4
(No Transcript)
5
(No Transcript)
6
chest trauma/chest injury/thoracic trauma

• ????????????????????????????????????????????
  ????????????????????????????????????????????
• blunt chest injuries / non penetrating chest
  injury ?????????????????????????????????????????
  ?????????
• penetrating chest injuries ?????? ??????
  ??????????

7
Blunt chest trauma
8
penetrating chest injuries
9
????????????????????????????
Company Logo
10
Fractured ribs

• ??????????????? ??????????????????????????????????
  ? ???? ????? ?????? ????? ????
• ?????????????????????????????????? 5-10
• ???????????? ???????????? ????????? ????
  atelectasis ??? pneumonia
• ??????????????????????????????????????????????????
  ???? ????hemothorax ???

11
Fractured ribs
12
Flail chest

• ????????????????????????? 3 ?????????
  ??????????????????????????????????????????????????
  ?????????? sternum
• ???????????????????????? ???????? Floating
  Segment

13

• paradoxical respiration
• ???????????????????????? ???????????????????
• ???????????????????????????????

14
Lung contusion

• ?????????????????? (wave) ??????????????????????
  ??????????????????????????
• ???????????????????????? ????????????
  ?????????????? ????????
• ???????????????????????????

15
Lung contusion
16
Lung contusion

• The 3 components
• edema,
• hemorrhage
• atelectasis

• ?????????????????????????
• ??????????????????????
• ?????????????????????

Company Logo
17
Lung contusion
lower-lobe lung contusion
18
Pneumothorax

• Simple pneumothorax/Closed pneumothorax
  ????????????????????????????/????????????
• Open pneumothorax ???????????????????????????????
  ???????
• Tension pneumothorax ????????????????????????????
  ?????????? ???????????????????????????????????????
  ? ????????????????????????????????????????????????
  ???????

19
(No Transcript)
20
Tension pneumothorax a one way valve allows air
into the pleural space during inspiration but not
out during expiration
Company Logo
21
Tension pneumothorax
22
Tension pneumothorax
23
Hemothorax

• ??????????????????????????????????????????????????
  ??????????????????????????????
• ???????????????????????????? ?????????????????????
  ??????????????????????????????????????????????????
  ? ??????????? hypovolemic shock ???
• minimal hemothorax 250-350 ml.
  ????????????????????????????????????? 10-14 ???
• moderate hemothorax 350-1,500 ml.
  ????????????????? ?????????? ?????????????????????
  ??
• massive hemothorax gt 1,500 ml./hr.
  ??????????????????? gt 400 ml. ???? 2-3
  ?????????????????????? 200-300 ml.

24
(No Transcript)
25
?????????????? ??????????????
26
????????????????????????????

• ????????????? ???????????????????????????????????
  
• ??????????????
• ????? ?????????? V/S ????????????????????????????
  ? ????????????????? subcutaneous emphysema
  ?????????????????????????????????????? cardiac
  tamponade
• ??????? ????????????? ??????? ?????? ?????
• ???????
• ??????????????? (haemothorax / pulmonary
  contusion) ?????????????????? (pneumothorax)
• ????????? ??????????????????? (cardiac tamponade)

27
?????
28
Subcutaneous emphysema
29
Engorged Neck Veins
30
????????????????????????????

• ?????? ?????????? ??????????
• ????????????????????????
• Hb ??? Hct ???? ??????????????????????
• PaO2 ???? ??? PaCO2 ????????? ????????????????????
  ?????????
• CPK-MB / cardiac troponin T ???????
  ?????????????? cardiac contusion
• ????????????????????????? CXR, CT Scan, MRI
  Scan, angiography, Transesophageal
  echocardiography (TEE)

31
Transverse image
Heamothorax
CT scan
32
???????????????????????????

• Fractured ribs
• ????????????????????????? ????????????????????????
  ????????????????????
• ??????????????
• ????? elastic adhesive strapping
• intercostal nerve block marcaine/xylocaine

33

• Fractured ribs

elastic adhesive strapping
Company Logo
34
???????????????????????????

• Flail chest stabilizing chest wall
• ????????/?????????????????????/???????????????????
  ??? ??????
• ??????????????????????
• ?????? towel clips ??????????? ???????????????????
  ?????????????????????????????
• ????? internal fixation ???????

35

• Flail chest

Company Logo
36
Towel clips ?????? traction
Internal fixation ??????????
37
???????????????????????????

• Flail chest
• ??????????????????????????????????
  ??????????????????????????????????
• ????????????????????????????????????????????????
• ??????????????????????????????????????????????????
  ?????????????????????

38
???????????????????????????

• Lung contusion
• ?????????????????????? ???????????????????????
• ????????????? IV fluid ??????? CVP, PAP
• steroid ??????????????????????????????????????????
  ?????
• ????????????????

39
???????????????????????????

• Pneumothorax
• Closed pneumothorax ????????????????????????? 20
  ????????????? ICD
• Open pneumothorax ????????? ?????????????????
  ??????????????????? ????????????? ICD
• Tension pneumothorax ???????????? 14/16
  ????????????????????????????????? ICS 2th MCL
  ?????????? ICS 5th AAL ????????????
  ?????????????? ICD

40
(No Transcript)
41
??????????? Open pneumothorax
42
?????????????????????????????????
ICS 2- 3 MCL
43
(No Transcript)
44
???????????????????????????

• Hemothorax
• ?????????????????????????????? IV fluid ???????
  CVP, PAP
• ??????????????????????????????????
  thoracentesis, ICD
• Thoracotomy ????????????? gt 1,200-1,500 ml.?????
  ???? gt 100-200 ml./hr. ???????? 4-6 ???????

45
Company Logo
46
(No Transcript)
47
??????????????

• single-bottle water sealed system
• two-bottle water sealed system
• three-bottle water sealed system

48
??????????????

• single-bottle water sealed system
• ????? ?????????? ??????????????????????????
• ??????? ???????????????? ?????????????????????????
  ???????
• ??????????????????
• ?????????????????????????
• ?????????????????????????????
• ??????????????????

49
??????????????

• two-bottle water sealed system
• ????? ????????????????????? ??????????????????????
  ??????
• ????????????????????????????????????????????
• ??????????????????????????????????????????????????
  ????????
• ???????????????????????????????????????????
• ???????
• ????????????????????????
• ?????????????????????????????

50
??????????????

• three-bottle water sealed system
• ??????????????? ???????????????? 2 ???

51
Company Logo
52
Company Logo
53
Company Logo
54
???????????????????????

• ?????????????????????????????????????????
  ?????????...
• ?????????????????????????????? ?????????...
• ????????????????????? ?????????....
• ?????????? ???????????????????????????????
• CO ???? ?????????????????????????????????????????
  ????????
• ??????????????????????????????????????
  ??????????????????????????
• ??????????????? ?????????...

55
?????????

• ????????????????????????????
• ????????? Semi fowler ???? Fowlers position
• ?????????????????????????
• ??????????????? ??????????????????????????????????
  ???????????????????????????
• V/S ??? 15-30 ????/1 ??????? ?????????????????????
  ????????????
• ??????? CVP, PAP, urine output ??? 1-2 ???????
• ?????????????????? IV fluid ??????? intake
  output
• ?????????????????????????????????????????????
  ???????????????????????????????????? thoracotomy

56
?????????

• S/S ?????????????????????????? ???????????????????
  ?????? ?????????????????????? Semi fowler
  ?????????????????????
• ????????????? ICD
• ???????????????? ICD ????????????????
  fluctuation, milking or stripping,
  ????????????????????????????????????,
  ???????????????????????????????????????,
  ???????????????????, ?????????
• ?????????????????? clamp, under waterseal,
  ????????????????????? vaseline gauze ??????????
  gauze ??? ????????????????

57
?????????

• ????????????? ICD
• ?????????????????? ?????????????, aseptic
  technique, ??????????? ?????? ????????? exudate
• ?????????????????????????? breathing exercise,
  skeletal exercise
• ?????????????????????????????????????? deep
  breathing, effective cough, turning
• ???????????????????????????????????
• ???????????????????? ?????????????????????????????
  ?????????????
• ?????????????????????????????????????????
  ???????????????????????

58
(No Transcript)
59
incentive spirometer
60
breathing exercise

• Place your lips tightly around the mouthpiece.
• Make sure the device is upright and not tilted.
• Breathe in slowly and deeply. Fill your lungs
  with as much air as you can. If you inhale too
  quickly, the spirometer may make a noise. If you
  hear this noise, inhale more slowly.
• Hold your breath long enough to keep the balls
  (or disk) raised for at least 3 seconds.
• Perform this exercise every hour while youre
  awake or as often as your doctor instructs.
• If you were also taught coughing exercises,
  perform them regularly as instructed.

61

• ?????????
• ??? ?. ??????????????????????????????????
  ????????????????????????????? ????????????????
  ???????????????????????????? ?????????????????
  ?????????? ???????????????????????????????????????
  ??????????????????? ???????????????????? ????????
  36.3 ???????????? ????? 110 ?????/???? ????? 28
  ?????/???? ???????????? 90/60 ?????????????
  ???????????????????????????? ?????????????????????
  ????????? 350 ??. ????????????????? 200 ??.

62

• ?????
• 1. ??? ?. ?????????????????????????
• 2. ???????????????????????????????????????????????
  ???????

63
Thank You !

• www.themegallery.com