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Thoracic Trauma

Thoracic Trauma

Chest Injuries: 16,000 deaths, 20% of all traumatic deaths, second leading cause of trauma death. Rapid transport is their best chance = less than 10 min in the field.

Chest Injuries that interfere with Ventilation

  • Clavicle: most commonly fractured bones, usually not significant injury
  • Rib Fracture: most commonly 3 through 8, more likely in adults, significant if underlying organs are damaged by force or broken bone ends
  • Sternal Fracture: not common, mortality rate 25-45% unstable chest wall, myocardial injury, cardiac tamponade
  • Flail Chest: 2 or more ribs broken in 3 or more places> paradoxicalmotion>hypoxia and hypercarbia
  • Pulmonary Contusion: bleeding in interstitial and alveolar areas of the lung, 50% with blunt chest trauma have it, profound hypoxemia may develop

Closed Pneumothorax: air enters the pleural space, negative pressure won’t allow lung to inflate>lung collapse. Treatment: needle thoracentesis

Open Pneumothorax (sucking chest wound): penetrating trauma creates opening into the intrathoracic cavity. Air freely enters/exits the pleural cavity. Severe ventilatory dysfunction, hypoxemia, death. Seal with occlusive dressing, create flutter valve to prevent tension pneumo

Tension Pneumothorax: air enter the pleural space but cannot exit, pressure builds and collapse the lung. Heart becomes compressed. Trachea deviates over away from the collapsed lung.

Airway injuries: Esophagus, Trachea, Bronchi – penetrating trauma can rupture airway structures. Not common, but more than 30% mortality rate when they do happen

Diaphragmatic rupture: abdominal contents can rupture through the thin diaphragm wall and enter the chest cavity.

Compressed lungs, heart function poorly >>> shock

Traumatic Asphyxia: severe crush to chest and abdomen. Forces blood up to thorax, neck, face can lead to seizure coma death.

Injuries that interfere with Circulation

  • Hemothorax: blood collects in the pleural space, symptoms are loss of blood and hypotension
  • Hemopneumothorax: air and blood accumulate in the pleural cavity
  • Myocardial Contusion: electrical problems, bruising to complete rupture
  • Pericardial Tamponade: Blood (150-200 ml) fills the space between the heart and its liner, the pericardium, heart is compressed and can’t expand to receive blood >>> cardiac output decreased >>> hypotension
  • Myocardial Rupture: Compression ruptures chamber walls, septum, valves
  • Aortic Rupture: high energy accidents, sheer forces tear the heart and aortic arch.
    • 80-90% fatal within an hour

Management of airway and respiratory complications is a priority.

  • Transport unresponsive patients supine, immobilized on a backboard
  • Protect the cervical spine
  • High concentration O2
  • Intubation for apneic, agonal respirations
  • Positive End Expiratory Pressure (PEEP)
    • 1 or 2 large bore (14-16 gauge) IV lines of lactated Ringers solution with a macroset en route

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