Chest Trauma
Organs/Vessels
Thoracic cavity Ribs Diaphragm Mediastinum (trachea, vena cava, aorta,
esophagus, heart) Lungs
Chest Anatomy
Pleura
2 Layers Keep lungs expanded Visceral layer Parietal layer
Pleural space Small amount of fluid
Pericardial Cavity
Fibrous pericardium Epicardium Potential space - < 50 ml of fluid
Pericardial Membranes
Other Considerations
Liver and spleen located under lower ribsTrauma Below nipples – Assume abdominal injuries
Trauma Above nipples – Assume cervical spine injuryAlways consider spinal column trauma
GSW can damage both cavitiesChest and abdominal trauma victims get high flow oxygen
Other Considerations
Major chest and abdominal trauma regularly occur together
When you see one, look for the other I bet you will find it
Hypoxia Consideration(End Point) Airway obstruction inadequate oxygen delivery Hypovolemia from blood loss Ventilation/perfusion mismatch from lung injury Changes in pleural pressures Pump failure
Manage hypoxia!!Airway controlRapid
Transport
Trauma Injury Effects
Heart – Ineffective pumping, blood loss Major vessels – Immediate & severe
blood loss Lungs – Ineffective ventilation Trachea - Obstruction Ribs – Ineffective chest expansion Diaphragm – Ineffective contraction
Deadly Dozen
Airway obstruction Open pneumothorax Tension pneumothorax Massive hemothorax Flail chest Cardiac tamponade
Traumatic aortic rupture
Tracheal/bronchial tree injury
Myocardial contusion Diaphragmatic tears Esophageal injury Pulmonary contusion
CLOSED CHEST INJURY
Closed (Blunt) – Falls, automobile crashes, direct blows to the chest Force distributed over large area
OPEN CHEST INJURY
Open (Penetrating) – Knife, GSW, ice picks, broken glass, nails Force distributed
over a small area
Blunt Trauma
Penetrating Trauma
Pneumothorax
Blunt or penetrating trauma Chest wall penetrated and air flows into the
thoracic cavity around the lungs Visceral and parietal pleura – air in pleural
space collapses the lung No penetration possible (broken rib), lung
laceration - most common
Pneumothorax
Pneumothorax S/S
Pneumothorax RX
Oxygen Reassessment (tension pneumothorax
possible) Transport
Sucking Chest Wound
Penetrating trauma An open chest wound that sucks air into the
wound; a noticeable sucking sound may be heard. Additional air being sucked into cavity Trapped air
Cover with gloved hand, or occlusive dressing (tape 3 sides)
Life Threat
Sucking Chest Wound
Tension Pneumothorax
Blunt or penetrating When air builds up collapsing one or both
lungsCan compresses large vessels and heart
Tension Pneumothorax S/S
Tension Pneumothorax RX
High flow oxygen Reassessment Rapid transport Open sucking wound? Occlusive dressing –
3 sides taped
Rib Fractures
Pain Most commonly blunt trauma Most commonly injured Reduced chest excursion – limits ventilation Consider pulmonary and/or myocardial contusions Consider pneumo/hemothorax
Rib Fractures S/S
Dyspnea Shallow respirations Guarding (self splinting) Painful respirations Tender, unstable ribs
Rib Fractures RX
Oxygen Splint? Reassessment Transport
Flail Chest
Major force involved Two or more adjacent ribs are broken in two or more
places Unattached segment (flail segment) Paradoxical movement (opposite movement of the rest of
the chest) Consider underlying injuries Stabilize with hand initially, splint later Life Threat
Flail Segment S/S
Tenderness, unstable segment Dyspnea Shallow respirations Guarding (self splinting) Painful respirations Paradoxical movement Shock
Flail Segment R/X
Provide high flow oxygen Assist ventilations, if required Stabilize flail segment (hand then bulky
dressings) Reassessment – Consider underlying
injuries Rapid Transport
Hemothorax
Penetrating and blunt trauma Rapid accumulation of blood in the chest
(greater than 1500 ml) Chest cavity can hold entire blood content
Hemothorax S/S
Cyanosis Flat neck veins Respiratory distress Shock Cold clammy skin Breath sounds absent, hypo resonant
Hemothorax RX
High flow oxygen Ventilate, as needed Rapid assessment Reassessment Rapid Transport
Traumatic Asphyxia
Severe crush injury (blunt force) to the chest
Compression of the superior vena cava Petechiae present Cerebral edema Head and neck swelling (tongue and lips) Conjunctival hemorrhage
Traumatic Asphyxia S/S
Swollen tongue, lips Bloodshot eyes Protruding eyes Chest trauma (blunt force)
Traumatic Asphyxia RX
CPR CABC High flow oxygen Ventilate Rapid transport
Pericardial Tamponade
Penetrating trauma common Blood filling the pericardial sack 15 ml – 20 ml of fluid removal may be life
saving
Pericardial Tamponade S/S
Beck’s Triad Distended neck veins Muffled heart sounds Hypotension
Tachycardia Narrowed pulse pressure Trachea midline Normal breath sounds
Pericardial Tamponade RX
High flow oxygen Ventilate, as needed Rapid transport Reassessment
Impaled Object in the Chest
Stabilize with dressings, build up around object Do not remove
Relevant Chest TraumaSAMPLE History GSW
Caliber, distance, number of shots, angle Stab Wounds
Length of blade, type of blade (smooth/serrated), sex of the stabber
FallsHeight, surface landed on, body part
landed on
Assessment TechniquesPage 954 & 956
Inspection (observation) – DCAP BTLS Palpation (touch) – Instability Percussion (sound waves) – Striking an
object and listening to the sound made Auscultation (listening) – Stethoscope;
breath sounds, heart tones
Palpation
Auscultation
Assessment Techniques
Vital signsBPPulseRespirationsBody Temperature
MOI Considerations
Page 217– “Scene Size- up” section Automobile crash – steering wheel Sports accident Fall GSW Fight Crush injury Explosion
Load-N-GoChest Injuries
Pneumothorax (tension too) Flail chest Hemothorax Sucking chest wound Traumatic asphyxia Pericardial tamponade
Terms
Paradoxical respirations
Asymmetrical chest wall movement that lessens respiratory efficiency
Terms
Hemoptysis
Coughing up blood
Terms
Occlusive Dressing
A dressing that can form an airtight seal over a wound
Terms
Decreased Pulse Pressure
The difference between the systolic and diastolic blood pressures. Narrowing seen with pericardial tamponade.
Terms
Subcutaneous Emphysema
Presence of air in the subcutaneous tissue; the resulting crackling sensation or sound
Tension Pneumothorax page 945
Build up of air and pressure in the thoracic cavity of the injured lung is so severe that it places pressure on the uninjured lung.
Results in compression of the heart, large vessels, and the uninjured lung.
TRUE EMERGENCY
BAD STUFF
BAD STUFF
QUESTIONS ?