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8/19/2019 06 Thoracic Trauma
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THORACIC TRAUMATHORACIC TRAUMATHORACIC TRAUMATHORACIC TRAUMA
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OVERVIEWOVERVIEWOVERVIEWOVERVIEW
• Review thoracic anatomyReview thoracic anatomy
• Review thoracic assessmentReview thoracic assessment
• Review pathophysiology andReview pathophysiology andmanagement o the !"eadlymanagement o the !"eadly"o#en$ thoracic in%&ries"o#en$ thoracic in%&ries
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THORACICTHORACIC
A'ATOM(A'ATOM(
THORACICTHORACIC
A'ATOM(A'ATOM(
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THORACICTHORACIC
A'ATOM(A'ATOM(
THORACICTHORACIC
A'ATOM(A'ATOM(
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A))E))ME'T* +I,E THREAT)A))E))ME'T* +I,E THREAT),OU'" I' THE -RIMAR( )URVE(,OU'" I' THE -RIMAR( )URVE(
A))E))ME'T* +I,E THREAT)A))E))ME'T* +I,E THREAT),OU'" I' THE -RIMAR( )URVE(,OU'" I' THE -RIMAR( )URVE(
• Airway o.str&ctionAirway o.str&ction
• Open pne&mothora/Open pne&mothora/
• Tension pne&mothora/Tension pne&mothora/
• Massive hemothora/Massive hemothora/
• ,lail chest,lail chest
• Cardiac tamponadeCardiac tamponade
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+I,E THREAT) THAT CA''OT 0E+I,E THREAT) THAT CA''OT 0E"IA1'O)E" I' THE ,IE+""IA1'O)E" I' THE ,IE+"
+I,E THREAT) THAT CA''OT 0E+I,E THREAT) THAT CA''OT 0E"IA1'O)E" I' THE ,IE+""IA1'O)E" I' THE ,IE+"
• -&lmonary cont&sion-&lmonary cont&sion
• Myocardial cont&sionMyocardial cont&sion
• 0ronchial disr&ption0ronchial disr&ption
• Esophageal in%&ryEsophageal in%&ry
• "iaphragmatic tear "iaphragmatic tear
• Thoracic aortic disr&ptionThoracic aortic disr&ption
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O-E'O-E'
-'EUMOTHORA2-'EUMOTHORA2
O-E'O-E'
-'EUMOTHORA2-'EUMOTHORA2
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MA'A1EME'T O-E'MA'A1EME'T O-E'-'EUMOTHORA2-'EUMOTHORA2
MA'A1EME'T O-E'MA'A1EME'T O-E'-'EUMOTHORA2-'EUMOTHORA2
• Ens&re ade3&ate airwayEns&re ade3&ate airway
• 4556 o/ygen4556 o/ygen
•)eal open wo&nd)eal open wo&nd• +oad 7 1o+oad 7 1o
• IV access en ro&teIV access en ro&te
• 'otiy Medical "irection'otiy Medical "irection Courtesy of David Effron, M.D.
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)EA+I'1 THE O-E')EA+I'1 THE O-E'
WOU'"WOU'"
)EA+I'1 THE O-E')EA+I'1 THE O-E'
WOU'"WOU'"
Asherman chest seal is very eective
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)EA+I'1 THE O-E')EA+I'1 THE O-E'
WOU'"WOU'"
)EA+I'1 THE O-E')EA+I'1 THE O-E'
WOU'"WOU'"
(o& can &se impervio&s material taped on three sides
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TE')IO'TE')IO'
-'EUMOTHORA2-'EUMOTHORA2
TE')IO'TE')IO'
-'EUMOTHORA2-'EUMOTHORA2
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MA'A1EME'TMA'A1EME'TTE')IO' -'EUMOTHORA2TE')IO' -'EUMOTHORA2
MA'A1EME'TMA'A1EME'TTE')IO' -'EUMOTHORA2TE')IO' -'EUMOTHORA2
• Ens&re ade3&ate airwayEns&re ade3&ate airway
• 4556 o/ygen4556 o/ygen
• 'eedle decompression i indicated'eedle decompression i indicated• +oad 7 1o+oad 7 1o
• IV access en ro&teIV access en ro&te
• 'otiy Medical "irection'otiy Medical "irection
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I'"ICATIO') TOI'"ICATIO') TO"ECOM-RE)) TE')IO'"ECOM-RE)) TE')IO'
-'EUMOTHORA2-'EUMOTHORA2
I'"ICATIO') TOI'"ICATIO') TO"ECOM-RE)) TE')IO'"ECOM-RE)) TE')IO'
-'EUMOTHORA2-'EUMOTHORA2
• The presence o tensionThe presence o tensionpne&mothora/ withpne&mothora/ with
decompensation as evidenced .ydecompensation as evidenced .ymore than onemore than one o the ollowing*o the ollowing*
– Respiratory distress and cyanosis
– Loss of radial pulse (late shock
– Decreasin! L"C
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MA))IVEMA))IVE
HEMOTHORA2HEMOTHORA2
MA))IVEMA))IVE
HEMOTHORA2HEMOTHORA2
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MA'A1EME'TMA'A1EME'TMA))IVE HEMOTHORA2MA))IVE HEMOTHORA2
MA'A1EME'TMA'A1EME'TMA))IVE HEMOTHORA2MA))IVE HEMOTHORA2
• Ens&re ade3&ate airwayEns&re ade3&ate airway
• 4556 o/ygen4556 o/ygen
• +oad 7 1o+oad 7 1o• IV access en ro&teIV access en ro&te
• 'otiy Medical "irection'otiy Medical "irection
• O.serve or development oO.serve or development otension hemopne&mothora/tension hemopne&mothora/
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,+AI+ CHE)T,+AI+ CHE)T,+AI+ CHE)T,+AI+ CHE)T
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MA'A1EME'TMA'A1EME'T,+AI+ CHE)T,+AI+ CHE)T
MA'A1EME'TMA'A1EME'T,+AI+ CHE)T,+AI+ CHE)T
• Ens&re ade3&ate airwayEns&re ade3&ate airway
• 4556 o/ygen4556 o/ygen
• -ossi.le int&.ation-ossi.le int&.ation
• +oad 7 1o+oad 7 1o
• )ta.ili#e lail segment)ta.ili#e lail segment
• IV access en ro&teIV access en ro&te
• Monitor EC1Monitor EC1• 'otiy Medical "irection'otiy Medical "irection
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CAR"IACCAR"IAC
TAM-O'A"ETAM-O'A"E
CAR"IACCAR"IAC
TAM-O'A"ETAM-O'A"E
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MA'A1EME'TMA'A1EME'TCAR"IAC TAM-O'A"ECAR"IAC TAM-O'A"E
MA'A1EME'TMA'A1EME'TCAR"IAC TAM-O'A"ECAR"IAC TAM-O'A"E
• Ens&re ade3&ate airwayEns&re ade3&ate airway
• 4556 o/ygen4556 o/ygen
• +oad 7 1o+oad 7 1o• IV access en ro&teIV access en ro&te
• Monitor EC1Monitor EC1
• 'otiy Medical "irection'otiy Medical "irection
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MA'A1EME'TMA'A1EME'TIM-A+E" O08ECT)IM-A+E" O08ECT)
MA'A1EME'TMA'A1EME'TIM-A+E" O08ECT)IM-A+E" O08ECT)
• Ens&re ade3&ate airwayEns&re ade3&ate airway
• 4556 o/ygen4556 o/ygen
• )ta.ili#e o.%ect)ta.ili#e o.%ect
– Do not re#ove$• +oad 7 1o+oad 7 1o
• IV access en ro&teIV access en ro&te
• Watch or developmentWatch or developmento tension pne&mothora/o tension pne&mothora/or hemothora/or hemothora/
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OTHER CHE)TOTHER CHE)T
I'8URIE)I'8URIE)
OTHER CHE)TOTHER CHE)T
I'8URIE)I'8URIE)
• Tra&matic aortic tear Tra&matic aortic tear
– %uspect &ith hi!h'i#pact inuries
– )sually dead on'scene
• Myocardial cont&sionMyocardial cont&sion – Looks like cardiac ta#ponade
– *lunt anterior chest trau#a
– Monitor EC+
• Esophageal in%&riesEsophageal in%&ries
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OTHER CHE)TOTHER CHE)T
I'8URIE)I'8URIE)
OTHER CHE)TOTHER CHE)T
I'8URIE)I'8URIE)
• "iaphragmatic tear "iaphragmatic tear
– Difficult to dia!nosis even at the hospital
– May hear o&el sounds in chest
• -&lmonary cont&sion-&lmonary cont&sion
– Most co##on pul#onary inury
– *lunt chest trau#a
– Dyspnea and cyanosis
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)UMMAR()UMMAR()UMMAR()UMMAR(
• -roper assessment-roper assessment
– Most inuries found in *-L% ri#ary%urvey
• ,re3&ently re3&ire +oad 7 1o,re3&ently re3&ire +oad 7 1o
• Airway is always irst priorityAirway is always irst priority
• 1ive 4556 o/ygen1ive 4556 o/ygen
• ,re3&ent Ongoing E/ams,re3&ent Ongoing E/ams
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9UE)TIO'):9UE)TIO'):9UE)TIO'):9UE)TIO'):