Thoracic Trauma

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Thoracic Trauma

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Classification and pathophysiology

• closed trauma
• 1) soft tissue bruise
• 2) rib fracture
• 3) hemothorax
• 4) pneumothorax
• 5) hemopneumothorax
• 6) hemopericardium
• 7) traumatic asphyxia
• 8) blast injury of lung

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open trauma

• Pneumothorax
• hemothorax
• effect of the function of respiration and
  circulation

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thoracic-abdominal injury
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Clinic manifestation

• chest pain the most chief symptom
• dyspnea
• 1) chest pain
• 2) block of trachea
• 3) pneumochysis
• 4) flail chest

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3. breathlessness, orthopnea,
dysphoria4. blood sputum or hemoptysis
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5. shock

• serious bleeding of intrathorax
• a large quantity of air in thoracic cavity
  (especially tension pneumothorax)
• hemopericardium

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6. local signs

• chest wall bruise
• paradoxical motion
• subcutaneous emphysema
• tenderness
• shift of trachea and heart
• percussion tympanic resonance or dull resonance
• auscultation distant breath sound or absent
  breath sound

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Diagnosis

• injured history and manifestation
• pleurocentesis
• roentgenogram

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Treatment

• stop (relieve) pain
• fixation chest wall
• debridement and suture of wound
• thoracentesis and tube thoracostomy
• thoracotomy for active bleeding
• use antibiotic to preventing infection

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Conditions requiring urgent thoracotomy

• continued intrapleural bleeding
• massive air leak
• acute or rapidly recurring pericardial tamponade
• thoraco-abdominal injury
• massive foreign matter retained in thorax

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RIB FRACTURE

• rib fracture is the most common disease of all
  thoracic trauma
• 47 ribs are longer and fixed, so they are easy
  to be broken

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etiology

• direct or indirect violence to the chest
• pathologic fracture

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pathophysiology

• pneumothorax, hemothorax
• flail chest, paradoxical movenent

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clinic manifestation

• pain, cough, dyspnea
• inspectation sign
• 1) swollen
• 2) tenderness
• 3) bony crepitus
• 4) paradoxical movement
• 5) subcutaneous emphysema
• chest roentgenogram

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treatment

• closed and single rib fracture stop pain,
  fixation and prevent complication
• flail chest
• 1) establishing and remaining a clear airway
• 2) restoring and maintaining a stabilized chest
  wall
• opening rib fracture
• 1) debridement and suture the wound
• 2) thoracic drainage for pleural rupture
• 3) use antibiotic to preventing infection

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closed pneumothorax most commonly, it is caused
by the rib fracture.small quantity pneumthorax
(lung collapse less than 30)the patients maybe
asymptom and do not require treating. 1. large
quantity pneumthorax (lung collapse more than 30)
PNEUMOTHORAX
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• 1) symptom chest distress, chest pain, short
  breath
• 2) inspectation sign
• I. trachea shift to the normal side
• II. tympanic percussion reasonance
• III. auscultation the breath sound become gentle
  or absent
• 3) X-ray different degrees of the lung collapse

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4) Treatment

• I. Thoracentesis
• II. Pleuracotomy
• III. Use antibiotic

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