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    Chest Trauma: Annet Mary Mathew Anu Krishna Arathi.K

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    Asif Abbas
    Chest trauma is the second leading cause of trauma deaths. Thoracic injuries can cause life-threatening conditions like tension pneumothorax, massive pneumothorax, and cardiac tamponade. Chest injuries are often classified based on their mechanism as either blunt or penetrating trauma. Clinical management follows ATLS protocols and involves stabilizing life-threatening injuries followed by treatment of potentially life-threatening injuries like flail chest or hemothorax. Complications of chest trauma include pneumothorax, hemothorax, and empyema which may require chest tube drainage or surgery.

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    Chest Trauma: Annet Mary Mathew Anu Krishna Arathi.K

    Uploaded by

    Asif Abbas
    82 views60 pages
    Chest trauma is the second leading cause of trauma deaths. Thoracic injuries can cause life-threatening conditions like tension pneumothorax, massive pneumothorax, and cardiac tamponade. Chest injuries are often classified based on their mechanism as either blunt or penetrating trauma. Clinical management follows ATLS protocols and involves stabilizing life-threatening injuries followed by treatment of potentially life-threatening injuries like flail chest or hemothorax. Complications of chest trauma include pneumothorax, hemothorax, and empyema which may require chest tube drainage or surgery.

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    CHEST TRAUMA1

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    Chest trauma is the second leading cause of trauma deaths. Thoracic injuries can cause life-threatening conditions like tension pneumothorax, massive pneumothorax, and cardiac tamponade. Chest injuries are often classified based on their mechanism as either blunt or penetrating trauma. Clinical management follows ATLS protocols and involves stabilizing life-threatening injuries followed by treatment of potentially life-threatening injuries like flail chest or hemothorax. Complications of chest trauma include pneumothorax, hemothorax, and empyema which may require chest tube drainage or surgery.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    82 views60 pages

    Chest Trauma: Annet Mary Mathew Anu Krishna Arathi.K

    Uploaded by

    Asif Abbas
    Chest trauma is the second leading cause of trauma deaths. Thoracic injuries can cause life-threatening conditions like tension pneumothorax, massive pneumothorax, and cardiac tamponade. Chest injuries are often classified based on their mechanism as either blunt or penetrating trauma. Clinical management follows ATLS protocols and involves stabilizing life-threatening injuries followed by treatment of potentially life-threatening injuries like flail chest or hemothorax. Complications of chest trauma include pneumothorax, hemothorax, and empyema which may require chest tube drainage or surgery.

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    of 60

    CHEST TRAUMA

    ANNET MARY MATHEW


    ANU KRISHNA
    ARATHI.K
    INTRODUCTION

     Second leading cause of trauma deaths


     Around 65-70% of chest injuries are due to
    RTA’s
     Thoracic
    trauma cause more than 50%
    trauma death
     80%of thoracic injury is managed
    conservatively
    MECHANISM OF CHEST INJURY

     Body acceleration and deceleration


    Eg;RTA
     Body compression
    Eg;fall from height
     Penetrating wounds
    Eg;Assaults-Stab and missile injuries
    CLASSIFICATION I OF CHEST INJURY
    BLUNT CHEST INJURY(CLOSED)
     Associated
    with multiple injuries such as
    head,limb,abdomen
    eg;RTA,fall from height,crush injuries
    PENETRATING CHEST INJURY(OPEN)
     Associated
    with chest wall damage,open
    pneumothorax and organ injury
    eg;seen in assault
    CLASSIFICATION II OF CHEST
    INJURIES
    IMMEDIATELY LIFE THREATENING POTENTIALLY LIFE TREATENING
    INJURIES INJURIES

    AIRWAY OBSTRUCTION TRACHEOBRONCHIAL DISRUPTION

    TENSION /OPEN PNEUMOTHORAX AORTIC INJURIES

    MASSIVE PNEUMOTHORAX MYOCARDIAL CONTUSION

    CARDIAC TAMPONADE RUPTURE OF DIAPHRAGM

    FLAIL CHEST ESOPHAGEAL INJURIES

    PULMONARY CONTUSION
    CLINICAL APPROACH- ATLS

     Advanced trauma life support


     Developedby American college of surgeons(ACS)
    committee on trauma
     Itwas first introduced in the US and abroad in
    1980
     It
    provide safe and reliable method for immediate
    management of injured patients
    CLINICAL APPROACH(ATLS)
    Primary survey Secondary survey

    Airway with cervical spine protection History taking

    Breathing and ventilation Thorough Head to toe


    examination
    Circulation with haemorrhage control
    Disability ,neurological status
    Exposure-completely undress the patient
    and look for other injuries
    FLAIL CHEST
     Occurs following blunt trauma
     Fracture of 3 or more consecutive ribs in
    two or more places
     Produces a comminuted fracture with a
    free floating unstable bony segment that is
    detached from the remaining chest wall
    DIAGNOSIS

     PARADOXICAL CHEST MOVEMENT


    The fractured segment,
    On inspiration;sink into the chest
    On expiration;expand out of the chest wall
    opposite to the normal chest
    wall mechanism
    PATHOPHYSIOLOGY

     Voluntary splinting of chest wall occus due to pain


    so mechanically impaired chest wall movement
    and associated lung contusion
     This leads to hypoxemia and hypercapnea
    CLINICAL FEATURES

    Symptoms:
     Dyspnea
     Tachycardia
     Tachypnea
     Pain

    Signs:
     tenderness
     On auscultation;decreased breath sounds over the
    affected area
    INVESTIGATION
     ChestX ray (PA view)-shows multiple rib
    fractures
     CT–To look tracheal deviation and
    associated spinal injuries and underlying
    pulmonary contusion.
     Pulse oximeter evaluation
    • SpO2 reduced (normal >97%)
     Arterial blood gas analysis
    • PaO2 reduced(normal 90-113mm Hg)
    • PaCO2 increased(normal 35-45mm Hg)
    TREATMENT

     1)Ifflail segment is small and not causing


    respiratory compromise – patient managed
    with oxygen support and regular blood gas
    analysis
     Patient should also receive good analgesic support
     It can be administered as;
    • Oral or rectal NSAIDS
    • Intercostal block(lignocaine)
    • Epidural anesthesia
     2)In patients developing respiratory failure
    despite oxygen and analgesia, endotracheal
    intubation and IPPV should be given for 1-2weeks
    till fracture become less mobile.
     Tracheostomy aid in recovery by ;
    • Increasing oxygen saturation by reducing dead
    space
    • Easy tracheal toileting
     3)SURGERY
    Open fixation may be done in patients with
    severe chest injury and pulmonary contusion.
    PNEUMOTHORAX

     Presence of air in pleural cavity


    CLASSIFICATION;
    1.Open pneumothorax
    2.Closed pneumothorax
    a) simple
    b) tension
    CAUSES

     TRAUMATIC
     SPONTANEOUS

    1.Tuberculous
    2.Non-tuberculous
    rupture of emphysematous bullae
    rupture of solitary lung cyst
    idiopathic
    OPEN PNEUMOTHORAX

     Due to open defect in chest >3cm


     leadsto equilibration between intrapleural
    and atmospheric pressure
     Airaccumulates in the pleura causes the
    compression of lungs leading to profound
    hypoventilation on affected side
    MANAGEMENT

     Closingthe defect with a sterile occlusive


    dressing
     Chest tube insertion as soon as possible in a
    site remote from injury site
     Definitive
    management-formal
    debridement and closure
    TENSION PNEUMOTHORAX
     Pneumothorax with rapid haemodynamic
    compromise
     Most common cause :
    a)penetrating chest trauma
    b)blunt trauma with air leak that did not
    close spontaneously
    c) iatrogenic lung puncture
    PATHOLOGY
     Developswhen a lung or chest wall injury is
    such that it allows air into the pleural space
    but not out of it(one way valve mechanism)

     Asa result air accumulates and compresses


    the lung resulting into;
    same side : lung collapse
    mediastinal shift
    compression over heart
    CLINICAL FEATURES
    Symptoms:
    Tachypnea
    Tachycardia
    Signs:
     Decreased cardiac output(Low BP with rapid
    pulse)
     Distended neck vein followed by raised JVP
     Trachea deviates to contralateral side(it is a late
    finding not necessary to clinically confirm
    diagnosis)
     On percussion –hyperresonant note
     Absent breath sound
    MANAGEMENT

    In Emergency,
     Needle thoracocentesis
    In adults – wide bore IV needle is used
    5th ICS in the mid clavicular line
    In children – in the 2nd ICS in the
    midclavicular line
    Definitive management:
     Insertionof ICT in the triangle of safety and
    cover sucking wound with gauze and tape
    on 3 sides
    HAEMOTHORAX

     Collection of blood in the pleural cavity


     Mostcommon cause – continuing bleeding
    from a torn intercostal vessels or
    occasionally from internal mammary artery
    CLINICAL FEATURES

     Flat neck veins


     Unilateral absence of breath sounds
     Haemorrhagic shock
     Dullness to percussion
    TREATMENT

     Correcting the hypovolemic


    shock(crystalloids or colloids)
     Insertion of ICT
     In some cases intubation
    SURGICAL METHOD

     Urgentthoracotomy (when initial drainage of


    more than 1.5 l of blood or ongoing haemorrhage
    of more than 200ml/hr over 3-4hrs
    INTERCOSTAL TUBE DRAINAGE

     Itis the method of draining fluid/blood/air


    collected in the pleural cavity safely , so as
    to allow the underlying lung to expand
    Indications

     Symptomatic Pneumothorax
     Haemothorax(>200 ml)
     Empyema
     Chylothorax
     hydrothorax
    CHEST TUBE DRAINAGE continued…
     Skin preparation and marking
     Administration of anaesthetic agent and
    skin incision
     Blunt dissection down to the intercostal
    muscles
     Digital examination along the tract into
    pleural space
     positioning of drain
     Chest tube inserted at upper border of the
    lower rib
     Otherend of the chest tube connected to
    underwater seal
     Aircomes out as bubbles and up and down
    movement of water column confirms right
    position
     Suture taken to secure chest tube to skin
    POSITION OF CHEST TUBE

     ChestX-ray to ensure correct positioning


    when all holes of chest tube are inside the
    thoracic cavity
     Stoppageof water column movement
    means blocked or displaced tube
     Excessive
    bubbling in water column means
    bronchopleural fistula
    WHEN TO REMOVE ICT

     When lung expands(on chest X ray)


     Breath sound present
     Output less than 100 cc/24 hour
     Patient able to hold breath at peak of
    inspiration
    COMPLICATIONS

     Clogging of ICT
     Injuryto intercostal nerves and
    vessels,liver,spleen,Aorta,heart
     Re-expansion pulmonary edema
     Subcutaneous emphysema
     Tube displacement
    EMPYEMA THORACIS
     Collection of pus in pleural cavity
     Itis the end stage of pleural infection from
    any cause
    CAUSES
    I.Pulmonary infection-Unresolved
    pneumonia,bronchiectasis,TB,fungal infection
    2.Aspiration of pleural effusion
    3.Trauma-penetrating injury,surgery,oesophageal
    perforation
    4.Extrapulmonary source-subphrenic abscess
    5.Bone infection-osteomyelitis of ribs,vertebrae
    PATHOGENESIS

     Exudative phase
    Collection of protein rich fluid infection
    Empyema
     Fibrinopurulent phase
    Fluid thickens fibrous tissue forms
     Organising phase
    Thick peel or cortex formed
    CLINICAL FEATURES

     Pain in the chest


     Fever
     Dyspnoea
     Decreased chest wall movements
     Dullness on percussion
     Absence of breath sound
    COMPLICATION

     Frozen chest(functionless lung)


     Empyema necessitans
     Bronchopleural fistula
     Pericarditis
     Disseminated infections
    INVESTIGATIONS

     Chest X ray(PA and lateral view)


    • Extension of the air fluid level to the chest
    wall
    • Lateral view helps in recognition of small
    volume of fluid
     CT –to differentiate empyema ,lung abscess,
    subdiaphragmatic fluid
     Needle aspiration
    • This confirms the presence of empyema
    • This is both diagnostic and therapeutic
     pus culture
     MRI to rule out carcinoma
    TREATMENT

     MEDICAL MANAGEMENT
    • Antibiotics
    • Thoracocentesis
    • Fibrinolysis
    SURGICAL MANAGEMENT

     ICTS
     VATS
     Thoracotomy
     STAGE 1-Antibiotics,thoracocentesis
     STAGE 2-ICT,VATS
     STAGE 3-Decortication
    VIDEO ASSISTED THORACOSCOPIC
    SURGERY
     Done when fluid component become
    fibrinopurulent and loculated
     Thepatient is positioned disease sided lung
    up and pleural cavity is entered
     Fluidand debris are vigorously debrided
    freeing the lung allowing for re-expansion
     Atthe end, chest drains are placed to allow
    for dependent drainage
     The drain must exit the skin anterior to mid
    axillary line or else patient will lie on
    drain, causing pain and obstruction of tube
     Following procedure , analgesia and
    physiotherapy to help fully re-expand the
    lung prior to removal of chest drains
    DECORTICATION

     Donewhen lung fails to re-expand after


    drainage of empyema
     Fibrouscortex or peel from the entrapped
    underlying lung is removed , so that lung
    can expand to obliterate pleural space
     Performedthrough a posterolateral
    thoracotomy
    THANK YOU

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