Professional Documents
Culture Documents
ACS
Thoracic Trauma
2
ACS
Objectives
Identify and treat injuries found during
the primary survey.
Identify and treat injuries found during
the secondary survey.
Demonstrate the ability to perform life
saving chest management.
Indications
Contraindications
3
ACS
Thoracic Trauma
1 out of 4 deaths
Blunt : < 10% require operation
Penetrating : 15% - 30% require operation
Majority : require simple procedures
4
ACS
Resuscitation
Airway control
Airway Obstruction
Laryngeal injury
Rare occurrence
Hoarseness
Subcutaneous emphysema
Treatment
Intubation (caution)
Tracheostomy (by surgeon)
8
ACS
Breathing
Breathing
Tension Pneumothorax : Signs / Symptoms
Respiratory distress
Distended neck veins
Unilateral in breath sounds
Hyperresonance
Cyanosis, late
10
ACS
Breathing
Tension
Pneumothorax
Immediate
decompression
Clinical diagnosis,
not by x-ray
11
ACS
Breathing
Open Pneumothorax
Cover defect
Chest tube
Definitive operation
12
ACS
Breathing
Flail chest
13
ACS
Breathing
Flail Chest / pulmonary Contusion
Reexpand lung
Oxygen
Judicious fluid management
Intubation as indicated
Analgesia
14
ACS
Circulation
Massive Hemothorax
1500 ml blood loss
Systemic / pulmonary vessel disruption
Flat vs distended neck veins
Shock with no breath sounds and /or
percussion dullness
15
ACS
Circulation
Massive Hemothorax
Rapid volume restoration
Chest decompression and x-ray
Autotransfusion
Operative intervention
16
ACS
Circulation
Cardiac Tamponade
Arterial pressure
Distended neck veins
Muffled heart sounds
PEA
17
ACS
Circulation
Cardiac Tamponade
Patent airway
IV therapy
Pericardiocentesis
Pericardiotomy
18
ACS
Resuscitative Thoracotomy
Qualified surgeon present on patients arrival
Indications
Blunt injury
Pulseless, without electrical activity
19
ACS
ABGs
Pulse oximetry
ECG
20
ACS
Secondary Survey
Pneumothorax
Penetrating / blunt
trauma
V / Q defect
Hyperresonance
Breath sounds
Tube thoracostomy
22
ACS
Secondary Survey
Hemothorax
Secondary Survey
Pulmonary Contusion
Most common
Oxygenate, ventilate
Selective intubation
24
ACS
Secondary Survey
Tracheobronchial injury
Frequently missed Treatment
injury Airway
Blunt / penetrating ventilation
trauma Operation
Partial vs complete
Diagnostic aid : Endoscopy
25
ACS
Secondary Survey
Blunt Cardiac Injury
Injury spectrum
Abnormal ECG : Monitor changes
Echocardiography
Treat : Dysrhythmias, Q, complications
26
ACS
Secondary Survey
Traumatic Aortic
Rupture
Rapid acceleration/
deceleration
Ligamentum
arteriosum
Salvage : identify early
Surgical consult
27
ACS
Secondary Survey
Diaphragmatic Rupture
Most diagnosed on left
Blunt large tears
Penetrating small
perforations
Misinterpreted x ray
Contrast radiography
Operation
28
ACS
Secondary Survey
Subcutaneous
Emphysema
Airway injury
Pneumothorax
Blast injury
33
ACS
Secondary Survey
Traumatic Asphyxia
Petechiae
Swelling
Plethora
Cerebral edema
34
ACS
Secondary Survey
Secondary Survey
Sternal, Scapular, and Rib Fractures
Ribs 1- 3
Severe force
Associated injuries High mortality
risk
Ribs 4 9
Pulmonary contusion
Pneumohemothorax
Ribs 10 12 : Suspect abdominal injury
36
ACS
Secondary Survey
Sternal, Scapular, and Rib Fractures :
Management
Secondary Survey
Esophageal Trauma
Blunt vs penetrating
Severe epigastric blow
Pain, shock > injury
Pneumohemothorax without fracture
38
ACS
Secondary Survey
Esophageal Trauma
Chest tube :
Particulate matter
Mediastinal air
Contrast swallow,
esophagoscopy
Operation
39
ACS
Secondary Survey
Other indication for Tube Thoracostomy
Suspected, severe lung injury
Pitfalls
Simple pneumothorax tension
pneumothorax
Retained hemothorax
Diaphragmatic injury
Delayed diagnosis of aortic injury
Severity of rib fractures pulmonary
contusion
Elderly
41
ACS
Questions
42
ACS
Summary
Common in multiply injured
Life threatening injuries
Monitoring