THORACIC%20TRAUMA

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THORACIC TRAUMA
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YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!
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INTRODUCTION

• Each year there are nearly 150,000 accidental
  deaths in the United States
• 25 of these deaths are a direct result of
  thoracic trauma
• An additional 25 of traumatic deaths have chest
  injury as a contributing factor

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MORTALITY OF CHEST WOUNDS DURING MILITARY
CAMPAIGNS
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REASON

• As a Ranger First Responder, you must be able
  to identify and treat penetrating trauma to the
  chest!

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Major Anatomy and Physiology of the Chest
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OVERVIEW

• Causes of Thoracic Trauma
• Types, Signs and Symptoms, and Management of
  Thoracic Trauma

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CAUSES OF THORACIC TRAUMA

• Falls
• 3 times the height of the patient
• Blast Injuries
• overpressure, plasma forced into alveoli
• Blunt Trauma
• PENETRATING TRAUMA

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OPEN PNEUMOTHORAX

• Develops when penetration injury to the chest
  allows the pleural space to be exposed to
  atmospheric pressure - Sucking Chest Wound
• Q- WHAT MAY CAUSE A SCW?
• Examples Include
• GSW, Stab Wounds, Impaled Objects, Etc...

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LARGE VS SMALL

• Severity is directly proportional to the size of
  the wound
• Atmospheric pressure forces air through the wound
  upon inspiration

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S/S OPEN PNEUMOTHORAX

• Shortness of Breath (SOB)
• Pain
• Sucking or gurgling sound as air moves in and out
  of the pleural space through the wound

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MANAGEMENT OF SCW

• Apply an Asherman Chest Seal
• Occlusive dressing with a release valve
• Observe for development of a
• Tension Pneumothorax

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TENSION PNEUMOTHORAX

• Air within thoracic cavity that cannot exit the
  pleural space
• Fatal if not immediately identified, treated,
  and reassessed for effective management

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Tension Pneumothorax Following Stab Wound
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EARLY S/S OF TENSION PNEUMOTHORAX

• ANXIETY!
• Increased respiratory distress
• Unilateral chest movement
• Unilateral decreased or absent breath sounds

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LATE S/S OF TENSION PNEUMOTHORAX

• Jugular Venous Distension (JVD)
• Tracheal Deviation
• Narrowing pulse pressure
• Signs of decompensating shock

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JVD TRACHEAL SHIFT

• Decreased input and output from the heart with
  compression of the great vessels

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JVD TRACHEAL SHIFT

• Increased pressure moves mediastinum and
  compresses the lung on the uninjured side

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MANAGEMENT OF TENSION PNEUMOTHORAX

• Asherman Chest Seal
• Needle Decompression
• High flow oxygen (If available)
• Bag Valve Mask / Intubation
• Chest Tube (BN CCP/CASEVAC)

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RGR MEDIC CHEST TUBE INSERTION
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NEEDLE THORACENTESIS

• Locate 2nd or 3rd Intercostal Space at the
  Midclavicular Line
• Insert a 14g needle/catheter over the top of the
  rib (VAN) into the pleural space
• Listen for air escape (WHOOSH!)
• Leave the catheter in place
• Reassess

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NEEDLE THORACENTESIS
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NEEDLE THORACENTESIS
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SUMMARY

• Reviewed anatomy and physiology of the chest
• Discussed causes of trauma to the chest
• Signs, symptoms, and emergent management of
• OPEN PNEUMOTHORAX
• Asherman Chest Seal
• TENSION PNEUMOTHORAX
• Needle Thoracentesis

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QUESTIONS?