Professional Documents
Culture Documents
Thoracic Trauma
BY : dr. ADRIAN KHU,SpOT
ACS
Objectives
ACS
Thoracic Trauma
1 out of 4 deaths
Blunt : < 10% require operation
Penetrating : 15% - 30% require operation
Majority : require simple procedures
ACS
Airway control
Ensure oxygenation/ventilation
ACS
Initial Assessment/Management
Secondary Survey
Identifies most
potentially lethal
injuries
Physical exam/
diagnostic tests
Definitive Care
Airway control
Ensure oxygenation
/ventilation
Tube thoracostomy
Hemodynamic
support
Operation
ACS
Airway obstruction
Tension pneumothorax
Open pneumothorax
Flail chest
Massive hemothorax
Cardiac tamponade
ACS
Airway Obstruction
Laryngeal injury
Rare occurrence
Hoarseness
Subcutaneous emphysema
Treatment
Intubation (caution)
Tracheostomy (by surgeon)
ACS
Breathing
Tension pneumothorax: Etiology
ACS
Breathing
Tension Pneumothorax : Signs / Symptoms
Respiratory distress
Distended neck veins
Unilateral in breath sounds
Hyperresonance
Cyanosis, late
ACS
Breathing
Tension
Pneumothorax
Immediate
decompression
Clinical diagnosis,
not by x-ray
ACS
Breathing
Open Pneumothorax
Cover defect
Chest tube
Definitive operation
ACS
Breathing
Flail chest
ACS
Breathing
Flail Chest/pulmonary Contusion
Reexpand lung
Oxygen
Intubation as indicated
Analgesia
ACS
Circulation
Massive Hemothorax
ACS
Circulation
Massive Hemothorax
Rapid volume restoration
Chest decompression and x-ray
Autotransfusion
Operative intervention
ACS
Circulation
Cardiac Tamponade
Arterial pressure
Distended neck veins
Muffled heart sounds
PEA
ACS
Circulation
Cardiac Tamponade
Patent airway
IV therapy
Pericardiocentesis
Pericardiotomy
ACS
Resuscitative Thoracotomy
Qualified surgeon presnt on patients arrival
Indications
Penetrating thoracic injury
Pulseless with electrical activity
Contraindications
Blunt injury
Pulseless without electrical activity
ACS
In depth examination
ABGs
Pulse oximetry
ECG
ACS
Simple pneumothorax
Hemothorax
Pulmonary contusion
Tracheobronchial tree injury
Blunt cardiac injury
Traumatic aortic disruption
Traumatic diagpramatic injury
Mediastinal traversing wounds
ACS
Secondary Survey
Pneumothorax
Penetrating /blunt
trauma
V / Q defect
Hyperresonance
Breath sounds
Tube thoracostomy
ACS
Secondary Survey
Hemothorax
ACS
Secondary Survey
Pulmonary Contusion
Most common
Oxygenate , ventilate
Selective intubation
ACS
Secondary Survey
Tracheobronchial injury
Frequently missed
injury
Blunt / penetrating
trauma
Partial vs complete
Diagnostic aid : Endoscopy
Treatment
Airway
ventilation
Operation
ACS
Secondary Survey
Blunt Cardiac Injury
Injury spectrum
Echocardiography
Secondary Survey
Traumatic Aortic
Rupture
Rapid acceleration/
deceleration
Ligamentum
arteriosum
Surgical consult
ACS
ACS
Secondary Survey
Diaphragmatic Rupture
Penetrating small
perforations
Misinterpreted x ray
Contrast radiography
Operation
ACS
Tension pneumothorax
Pericardial tamponade
ACS
Treatment
Bilateral tube thoracostomies
Emergent surgical consultation
ACS
Vascular : Angiography
Tracheobronchial : Bronchoscopy
Esophageal Esophagography,
esophagoscopy
ACS
Treatment
Mandatory surgical consultation
Repair identified injuries
ACS
Secondary Survey
Subcutaneous
Emphysema
Airway injury
Pneumothorax
Blast injury
ACS
Secondary Survey
Traumatic Asphyxia
Petechiae
Swelling
Plethora
Cerebral edema
ACS
Secondary Survey
Sternal, Scapular, and Rib Fracture:
Pathophysiology
Hemopneumothorax
Pain Splinting
Retained secretion
Associated injuries
Atelectasis pneumonia
Impaired ventilation
Pulmonary contusion
ACS
Secondary Survey
Sternal, Scapular, and Rib Fractures
Ribs 1- 3
Severe force
Associated injuries High mortality risk
Ribs 4 9
Pulmonary contusion
Pneumohemothorax
ACS
Secondary Survey
Sternal, Scapular, and Rib Fractures :
Management
Chest x ray
Chest tube as
necessary
Selective
ventilation
Adequate pain
relief
Treat associated injuries
No constrictive devices
ACS
Secondary Survey
Esophageal Trauma
Blunt vs penetrating
ACS
Secondary Survey
Esophageal Trauma
Chest tube :
Particulate matter
Mediastinal air
Contrast swallow,
esophagoscopy
Operation
ACS
Secondary Survey
Other indication for Tube Thoracostomy
ACS
Pitfalls
ACS
Questions
ACS
Summary