Thoracic Trauma
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YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!
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
MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS
REASON
As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!
OVERVIEW
Causes of Thoracic Trauma
Types, Signs and Symptoms, and Management of Thoracic Trauma
CAUSES OF THORACIC TRAUMA:
Falls
3 times the height of the patient
Blast Injuries
overpressure, plasma forced into alveoli
Blunt Trauma
PENETRATING TRAUMA
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…
LARGE VS SMALL
Severity is directly proportional to the size of the wound
Atmospheric pressure forces air through the wound upon inspiration
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
MANAGEMENT OF SCW
Apply an Asherman Chest Seal
Occlusive dressing with a release valve
Observe for development of a
Tension Pneumothorax
TENSION PNEUMOTHORAX
Air within thoracic cavity that cannot exit the pleural space
Fatal if not immediately identified, treated, and reassessed for effective management
Tension Pneumothorax Following Stab Wound
EARLY S/S OF TENSION PNEUMOTHORAX
ANXIETY!
Increased respiratory distress
Unilateral chest movement
Unilateral decreased or absent breath sounds
LATE S/S OF TENSION PNEUMOTHORAX
Jugular Venous Distension (JVD)
Tracheal Deviation
Narrowing pulse pressure
Signs of decompensating shock
JVD & TRACHEAL SHIFT
Decreased input and output from the heart with compression of the great vessels
JVD & TRACHEAL SHIFT
Increased pressure moves mediastinum and compresses the lung on the uninjured side
MANAGEMENT OF TENSION PNEUMOTHORAX
Asherman Chest Seal
Needle Decompression
High flow oxygen (If available)
Bag Valve Mask / Intubation
Chest Tube (BN CCP/CASEVAC)
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
NEEDLE THORACENTESIS
NEEDLE THORACENTESIS
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
QUESTIONS?
