CHEST TRAUMA

Sub Department of CARDIO THORACIC & VASCULAR SURGERY

Dr Moewardi Hospital
Surakarta
 Introduction
Chest trauma is often sudden and dramatic
Accounts for 25% of all trauma deaths
2/3 of deaths occur after reaching hospital
Serious pathological consequnces:
hypoxia,
hypovolaemia,
myocardial failure
 Mechanism of Injury
Penetrating Trauma
Low Energy
Arrows, knives, handguns
Injury caused by direct contact
High Energy
Military, hunting rifles & high powered hand guns
Extensive injury due to high pressure
Blunt injuries
Either:
direct blow (e.g. rib fracture)
deceleration injury
compression injury
Rib fracture is the most common sign of blunt thoracic
trauma
Fracture of scapula, sternum, or first rib suggests
massive force of injury
Age Factors
Pediatric Thorax: More cartilage = Absorbs forces
Geriatric Thorax: Calcification & osteoporosis = More fracture
 Injuries Associated with
Cardio Thoracic Vascular Trauma
Airway obstruction Tracheobronchial tree
Closed pneumothorax lacerations (rupture)
Open pneumothorax Esophageal lacerations
(sucking chest wound) Penetrating cardiac injuries
Tension pneumothorax Pericardial tamponade
Spinal cord injuries
Pneumomediastinum
Diaphragm trauma
Hemothorax (massive)
Intra-abdominal trauma
Hemopneumothorax associated organ injury
Rib fracture (flail chest) Laceration of vascular
structures (central &
peripheral)
Basic management concept
in traumatic patient
Is
ABCDE

Sub Department of Cardio Thoracic & Vascular Surgery

responsible in ABC
 Airway obstruction
Clinical finding
Shortness of breath (dyspnea)
Stridor
Apnea
Management
Chin lift
Jaw thrust
Triple finger manuever
Evacuate foreign body
ET insertion
Cricothyroidostomy
Tracheostomy
 Tension Pneumothorax
Ventile phenomenon
Build up of air under
pressure in the thorax.
Excessive pressure
reduces effectiveness
of respiration
Air is unable to escape
from inside the pleural
space
Progression of Simple
(closed) or Open
Pneumothorax
CXR image
 Tension Pneumothorax (simplify)
Anx: Progressive shortness of breath
PE :
Respiratory distress
Tracheal deviation (away)
Absence of breath sound & percusion: hypersonor
Jugular Vein Distend
Hypotension
Treatment :
Needle thoracocentesis
Consult : chest tube insertion
Needle thoracocentesis
OPEN (SUCKING) CHEST WOUND
SUCKING CHEST WOUND
SUCKING CHEST WOUND

Upon exhaling, air in

the chest escapes
through the flutter-type
valve created by taping
3 sides only
With inhaling, the patch
should suck against the
skin, preventing air
entry
 Hemothorax
Hemothorax
Accumulation of blood in the pleural space
Serious hemorrhage may accumulate 1,500 mL of blood
Mortality rate of 75%
Each side of thorax may hold up to 3,000 mL
MASSIVE (criteria)
Blood loss in thorax causes a decrease in tidal volume
Ventilation/Perfusion Mismatch & Shock
Typically accompanies pneumothorax
Hemopneumothorax
 Hemothorax (simplify)
Blunt or penetrating chest
trauma
Shock
Dyspnea
Tachycardia
Tachypnea
Diaphoresis
Hypotension massive
Dull to percussion over injured
side
Treatment
Chest tube insertion & consult
CXR Image

Trauma.org
 Flail chest
Multiple rib fractures produce a mobile
fragment which moves paradoxically with
respiration
Significant force required
Usually diagnosed clinically
Treatment
ABC
Analgesia
Fixation : internal &/ external
PARADOXICAL RESPIRATIONS
Flail Chest - detail
 Tracheobronchial Injury
MOI
Blunt trauma
Penetrating trauma
50% of patients with injury die within 1 hr of injury
Disruption can occur anywhere in tracheobronchial tree
Signs & Symptoms
Dyspnea
Cyanosis
Hemoptysis
Massive subcutaneous emphysema
Suspect/Evaluate for other closed chest trauma
 Tracheobronchial Injury
Observe for development of
Subcutaneus emphysema & tension
pneumothorax (deadly)

Treatment
Keep airway clear
Administer high flow O2
Consider intubation if unable to
maintain patient airway
If tension needle thoracocentesis
Consult : tracheal repair or
tracheostomy
 Pericardial Tamponade
Restriction to cardiac filling caused by blood or
other fluid within the pericardium
Occurs in <2% of all serious chest trauma
However, very high mortality
Results from tear in the coronary artery or
penetration of myocardium
Blood seeps into pericardium and is unable to escape
200-300 ml of blood can restrict effectiveness of
cardiac contractions
Removing as little as 20 ml can provide relief
 Pericardial Tamponade (simplify)
Dyspnea Kussmauls sign
Possible cyanosis Decrease or absence of
Becks Triad JVD during inspiration
JVD Pulsus Paradoxus
Distant heart tones Drop in SBP >10 during
inspiration
Hypotension or
Due to increase in CO2
narrowing pulse during inspiration
pressure
Electrical Alterans
Weak, thready pulse
P, QRS, & T amplitude
Shock changes in every other
cardiac cycle
PEA
Pericardial or Cardiac tamponade
Pericardial Tamponade (ilustrations)
 Laceration of vascular structures
General sign
Shock Hypovolemia (co morbid cardiogenic)
Penetrating trauma (mostly)
Internal bleeding
Thoracic Chest XR
Abdominal FAST or CT
Pelvicum CXR
Femur expanding hematoma + XR
External bleeding thorough examination &
suturing
 Laceration of vascular structures
Internal bleeding consult
External bleeding