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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?