Thoracic Trauma BY Prof/ Gouda Ellabban

Thoracic Trauma
BY
PROF/ GOUDA
ELLABBAN
Thoracic Trauma
Mechanisms of Injury
Blunt Injury
Deceleration
Compression
Penetrating Injury
Both
Thoracic Trauma
Anatomical Injuries
Thoracic Cage (Skeletal)

Cardiovascular
Pleural and Pulmonary
Mediastinal
Diaphragmatic
Esophageal
Penetrating Cardiac
Thoracic Trauma
General Pathophysiology
Impairments to cardiac output

blood
loss
increased intrapleural pressures
blood in pericardial sac
myocardial valve damage
vascular disruption
Thoracic Trauma
Impairments in ventilatory efficiency

chest
excursion compromise
pain
air in pleural space
asymmetrical movement
bleeding
in pleural space
ineffective diaphragm contraction
Thoracic Trauma
Impairments in gas exchange

atelectasis
pulmonary
contusion
respiratory tract disruption
Thoracic Trauma
Assessment Findings
Mental Status (decreased)

Pulse (absent, tachy or brady)
BP (narrow PP, hyper- or hypotension, pulsus
paradoxus)
Ventilatory rate & effort (tachy- or
bradypnea, labored, retractions)
Skin (diaphoresis, pallor, cyanosis, open
injury, ecchymosis)
Thoracic Trauma
Assessment Findings
Neck (tracheal position, SQ emphysema, JVD,

open injury)
Chest (contusions, tenderness, asymmetry,
absent or decreased lung sounds, bowel
sounds, abnormal percussion, open injury,
impaled object, crepitus, hemoptysis)
Heart Sounds (muffled, distant, regurgitant
murmur)
Upper abdomen (contusion, open injury)
Thoracic Trauma
Assessment Findings
ECG (ST segment abnormalities,

dysrhythmias)
History
Dyspnea
Pain
Past hx of cardiorespiratory disease
Restraint devices used
Item/Weapon involved in injury
Thoracic Trauma
Specific Injuries
Rib Fracture
Most common chest wall injury from
direct trauma
More common in adults than children
Especially common in elderly
Ribs form rings
Possibility of break in two places
Most commonly 5th - 9th ribs
Poor protection
Rib Fracture
Management
High concentration O2
Positive pressure ventilation as needed
Splint using pillow or swathes
Encourage pt to breath deeply
Helps
prevent atelectasis
Analgesics for isolated trauma

Non-circumferential splinting
Rib Fracture
Management
Monitor elderly and COPD patients closely

Broken
ribs can cause decompensation

Patients will fail to breathe deeply and cough,
resulting in poor clearance of secretions
Usually Non-Emergent Transport
Flail Chest
Two or more adjacent ribs
fractured in two or more places
producing a free floating
segment of the chest wall
Simple Pneumothorax
Incidence
10-30% in blunt chest trauma

almost 100% with penetrating chest trauma
Morbidity & Mortality dependent on
extent
of atelectasis
associated injuries
Simple Pneumothorax
Assessment Findings
Tachypnea, Tachycardia
Difficulty breathing or respiratory distress
Pleuritic pain
may
be referred to shoulder or arm on affected side
Decreased or absent breath sounds

not
always reliable
if patient standing, assess apices first

if supine, assess anteriorly
patients
with multiple ribs fractures may splint injured

side by not breathing deeply
Simple Pneumothorax
Management
Establish airway
High concentration O2 with NRB
Assist with BVM
decreased
or rapid respirations
inadequate TV
IV of LR/NS
Monitor for progression
Monitor ECG
Usually Non-emergent transport
Open Pneumothorax
Hole in chest wall that allows air to
enter pleural space.
Larger the hole the more likely air will
enter there than through the trachea.
Open Pneumothorax
Assessment Findings
Opening in the chest wall

Sucking sound on inhalation
Tachycardia
Tachypnea
Respiratory distress
SQ Emphysema
Decreased lung sounds on affected side
Open Pneumothorax
Management
Cover chest opening with occlusive dressing

Assist with positive pressure ventilations prn
Monitor for progression to tension
pneumothorax
IV with LR/NS
Monitor ECG
Emergent Transport
Trauma
Center
Tension Pneumothorax
Incidence
Penetrating Trauma
Blunt Trauma
Morbidity/Mortality
Severe hypoventilation
Immediate life-threat if not managed early
Hemothorax
Blood in the pleural space

Most common result of major trauma to the
chest wall
Present in 70 - 80% of penetrating and major
non-penetrating trauma cases
Associated with pneumothorax
Rib fractures are frequent cause
Hemothorax
Management
Establish airway
Assist Ventilations w/BVM prn
+ MAST in profound hypotension
Needle thoracostomy if tension & unable to
differentiate from Tension Pneumothorax
IVs x 2 with LR/NS
Monitor ECG
Emergent transport to Trauma Center
Pulmonary Contusion
Pathophysiology
Blunt trauma to the chest

Rapid
deceleration forces cause lung to strike chest
wall
high energy shock wave from explosion
high velocity missile wound
low velocity as with ice pick
Most common injury from blunt thoracic

trauma
30-75%
of blunt trauma
mortality 14-20%
Pulmonary Contusion
Management
Supportive therapy
Early use of positive pressure ventilation
reduces ventilator therapy duration
Avoid aggressive crystalloid infusion
Severe cases may require ventilator therapy
Emergent Transport
Trauma
Center
Traumatic Aortic Dissection/Rupture
Caused By:
Motor Vehicle Collisions

Falls from heights
Crushing chest trauma
Animal Kicks
Blunt chest trauma
15%
of all blunt trauma deaths
Traumatic Aortic Dissection/Rupture
Management
Establish airway
High concentration oxygen
Maintain minimal BP in dissection
minimize fluid administration
Emergent Transport
Trauma
Center
Vascular Surgery capability

Thoracic Trauma BY Prof/ Gouda Ellabban

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Thoracic Trauma

Thoracic Cage (Skeletal)

Impairments to cardiac output

Impairments in ventilatory efficiency

Impairments in gas exchange

Mental Status (decreased)

Neck (tracheal position, SQ emphysema, JVD,

ECG (ST segment abnormalities,

Possibility of break in two places

Most commonly 5th - 9th ribs

Analgesics for isolated trauma

Monitor elderly and COPD patients closely

ribs can cause decompensation

Usually Non-Emergent Transport

10-30% in blunt chest trauma

be referred to shoulder or arm on affected side

Decreased or absent breath sounds

if patient standing, assess apices first

with multiple ribs fractures may splint injured

Opening in the chest wall

Cover chest opening with occlusive dressing

Blood in the pleural space

Blunt trauma to the chest

deceleration forces cause lung to strike chest

Most common injury from blunt thoracic

Traumatic Aortic Dissection/Rupture

Motor Vehicle Collisions

of all blunt trauma deaths

Traumatic Aortic Dissection/Rupture

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