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THORACIC TRAUMABy
Dr.Saleh Bakar
YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!
INTRODUCTION• Each year there are nearly 150,000
accidental deaths in the United States
• 25% of these deaths are a direct result of thoracic trauma
• An additional 25% of traumatic deaths have chest injury as a contributing factor
MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS
0102030405060708090
100
Total Wounded
79% 63% 56% 25% 12%
% Chest Wound Related Deaths
Crimean War (1853-1856)
American Civil War(1861-1865)
Franco-PrussianWar (1870-1871)
World War I (1914-1918)
World War II (1939-1945)
REASON
As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!
Major Anatomy and Physiology of the Chest
OVERVIEW
• Causes of Thoracic Trauma
• Types, Signs and Symptoms, and Management of Thoracic Trauma
CAUSES OF THORACIC TRAUMA:
• Falls3 times the height of the patient
• Blast Injuriesoverpressure, plasma forced into alveoli
• Blunt Trauma • PENETRATING TRAUMA
OPEN PNEUMOTHORAX• Develops when penetration injury to the chest
allows the pleural space to be exposed to atmospheric pressure - “Sucking Chest Wound”
• Q- WHAT MAY CAUSE A SCW?
• Examples Include: GSW, Stab Wounds, Impaled Objects, Etc...
LARGE VS SMALL
• Severity is directly proportional to the size of the wound
• Atmospheric pressure forces air through the wound upon inspiration
S/S: OPEN PNEUMOTHORAX
• Shortness of Breath (SOB)
• Pain
• Sucking or gurgling sound as air moves in and out of the pleural space through the wound
MANAGEMENT OF SCW
• Apply an Asherman Chest Seal Occlusive dressing with a release valve
• Observe for development of a
Tension Pneumothorax
TENSION PNEUMOTHORAX
• Air within thoracic cavity that cannot exit the pleural space
• Fatal if not immediately identified, treated, and reassessed for effective management
Tension Pneumothorax Following Stab Wound
EARLY S/S OF TENSION PNEUMOTHORAX
• ANXIETY!
• Increased respiratory distress
• Unilateral chest movement
• Unilateral decreased or absent breath sounds
LATE S/S OF TENSION PNEUMOTHORAX
• Jugular Venous Distension (JVD)
• Tracheal Deviation
• Narrowing pulse pressure
• Signs of decompensating shock
JVD & TRACHEAL SHIFT
Decreased input and output from the heart with compression of the great vessels
JVD & TRACHEAL SHIFT
Increased pressure moves mediastinum and compresses the lung on the uninjured side
MANAGEMENT OF TENSION PNEUMOTHORAX
• Asherman Chest Seal
• Needle Decompression
• High flow oxygen (If available)
• Bag Valve Mask / Intubation
• Chest Tube (BN CCP/CASEVAC)
RGR MEDICCHEST TUBE INSERTION
NEEDLE THORACENTESIS• Locate 2nd or 3rd Intercostal Space at the Midclavicular Line
• Insert a 14g needle/catheter over the top of the rib (“VAN”) into the pleural space
• Listen for air escape (WHOOSH!)
• Leave the catheter in place
• Reassess
NEEDLE THORACENTESIS
NEEDLE THORACENTESIS
SUMMARY
• Reviewed anatomy and physiology of the chest• Discussed causes of trauma to the chest• Signs, symptoms, and emergent management of:
OPEN PNEUMOTHORAX
Asherman Chest Seal
TENSION PNEUMOTHORAX
Needle Thoracentesis
QUESTIONS?
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