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Chest Trauma

Anatomy of the chest


Two Lungs (right and left)
Heart
Diaphragm
Anatomy of the chest

Pleural Space
Anatomy of the pleural space
Connected to
Pleural space the ribs

Resembles two thin layers of


plastic. One wraps around the lungs
and one the inner surface of the
ribs. There is a thick fluid
between these layers and the
layers are vacum sealed. Vacum sealed
There are no ligaments or muscles
that actually attach the lung to
the chest wall...
Anatomy of the chest

Aorta
Anatomy of the chest
Veins
(Superior vena cava)

Veins
(Inferior vena cava)
Main causes of chest trauma
Blunt trauma: blunt force to the chest

Penetrating trauma: projectile that enters


causing a small or big hole
Compression injury: Where the chest is
caught between two objects and the chest is
compressed.
Injuries of the chest

➡ Simple/Open Pneumothorax
➡ Tension pneumothorax - lungs
➡ Massive hemothorax - lungs
➡ Flail Chest - skeleton and lungs
➡ Cardiac tamponade - heart
➡ Traumatic aortic disruption - heart
Open Pneumothorax
Inhale
Open Pneumothorax
Exhale
Open Pneumothorax
Inhale
Open Pneumothorax
Exhale
Open Pneumothorax
Inhale
Open Pneumothorax
Inhale
The is what we call a
“Sucking chest wound”
Signs and Symptoms
◆ Sudden sharp pain
◆ Decreased lung sounds to the affected side
◆ Severe shortness of breath
◆ Red bubble on exhalation from the wound
◆ Subcutaneous Emphysema
Subcutaneous Emphysema
 When a lung becomes lacerated and the air
escapes into the soft tissue of the chest.
 Feels like rice crispies or bubble wrap

 Can travel as far up as the neck and all the

way down to the groin.


 Usually seen in a lung injury but could occur

with a neck injury.


 Treatment:

 treat the underlying condition


Emergency Care for a
pneumothorax
❒ ABC’s
❒ High flow O2
❒ If there is an opening cover with a three
sided occlusive dressing.
❒ Monitor the lung and listen for any changes
❒ Notify ALS or the hospital as soon as
possible
Inhalation

Occlusive dressing
Exhalation
Injuries of the chest
➡ Simple/Open Pneumothorax - lungs
➡ Tension pneumothorax
➡ Massive hemothorax - lungs
➡ Flail - skeleton and lungs
➡ Cardiac tamponade - heart
➡ Traumatic aortic disruption - heart
Tension Pneumothorax
Tension Pneumothorax

No external
opening…

May be
caused
Damage to the by a rib
lung itself may
produce an puncturing
opening the lung or
the
“paper bag
syndrome”
Tension Pneumothorax
Tension Pneumothorax
Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..
Pneumothorax
Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..
Pneumothorax

The trachea is
pushed to
the good side

Heart is being
compressed
Pneumothorax
Signs and symptoms
♥ Decreased breath sounds
♥ SOB
♥ Cyanosis
♥ Decreased blood pressure
♥ Rapid and weak pulse
♥ Distended neck veins - why ???
Treatment for a
Tension Pneumothorax
 Maintain an open airway
 High flow O2

 As the heart becomes compressed it will not

pump properly. You may have to do CPR


 Treat for shock

 Notify the ambulance or the hospital of

what you suspect so as they may prepare for


your arrival...
Injuries of the chest
➡ Pneumothorax - lungs
➡ Tension pneumothorax - lungs
➡ Massive hemothorax
➡ Flail Chest
➡ Cardiac tamponade - heart
➡ Traumatic aortic disruption - heart
Hemothorax
Hemothorax
❏ A hemothorax occurs
when the pleural space
fills with blood.
Usually occurs due to
lacerated blood vessels
in the thorax
Hemothorax
Where does the blood come from.

Lots of blood vessels


Hemothorax
❏ As the blood fills the
lung it may start putting
pressure on the heart and
the other good lung.

❏ Each lung can hold up to


1.5 liters of blood…...
Hemothorax
❏ As the blood fills the
lung it may start putting
pressure on the heart and
the other good lung.

❏ Each lung can hold up to


1.5 liters of blood…...
Hemothorax
❏ As the blood fills the
lung it may start putting
pressure on the heart and
the other good lung.

❏ Each lung can hold up to


1.5 liters of blood…...
Hemothorax
❏ As the blood fills the
lung it may start putting
pressure on the heart and
the other good lung.

❏ Each lung can hold up to


1.5 liters of blood…...
Hemothorax
❏ As the blood fills the
lung it may start putting
pressure on the heart and
the other good lung.

❏ Each lung can hold up to


1.5 liters of blood…...
Hemothorax
❏ As the blood fills the
lung it may start putting
pressure on the heart and
the other good lung.

❏ Each lung can hold up to


1.5 liters of blood…...

May put pressure on the heart


Signs and Symptoms
of a Hemothorax
 Dependant on the amount of blood loss
 Common signs and symptoms include:

Rapid shallow breathing


Rapid heartbeat
Shock - if enough blood loss
Decrease in the blood pressure
Absent breath sounds on the affected side
 Neck veins are flat
Weak thready pulse (due to shock )
Frothy or bloody sputum
Treatment of a Hemothorax
✟ Secure the airway - assist if necessary
✟ High flow oxygen
✟ If possible - rapid transport
✟ Notify the hospital or ALS ASAP
Injuries of the chest
➡ Pneumothorax - lungs
➡ Tension pneumothorax - lungs
➡ Massive hemothorax - lungs
➡ Flail Chest
➡ Cardiac tamponade - heart
➡ Traumatic aortic disruption - heart
Flail Chest

❆ The breaking of 2
or more ribs in 2
or more places
Signs and symptoms
of a flail chest
✗ Shortness of breath
✗ Paradoxical movement
✗ Bruising and swelling
✗ Signs of shock
✗ Crepitus( the sound of bone grinding)

✗ Flail chest is a true emergency:


the sharps ends of the ribs can lacerate blood
vessels and puncture lungs.
Treatment of a flail chest
✒ Have the patient lie on their back
✒ ABC’s with high flow oxygen
✒ Bare the chest and tape a small pillow or
dressing in place. The objective is to splint
the segment so as it moves with the rest of
the chest.
✒ If necessary, treat for shock
✒ Monitor vitals
Injuries of the chest
➡ Pneumothorax - lungs
➡ Tension pneumothorax - lungs
➡ Massive hemothorax - lungs
➡ Flail Chest - skeleton and lungs
➡ Cardiac tamponade
➡ Traumatic aortic disruption - heart
Cardiac Tamponade
✸ Blood and fluids leak
into the pericardial
sac which surrounds
the heart.
✸ As the pericardial sac
fills, it causes the sac
to expand until it
cannot expand
anymore
pericardial sac
Cardiac Tamponade
✸ Once the pericardial
sac can’t expand
anymore, the fluid
starts putting pressure
on the heart

✸ Now the heart can’t


fully expand and can’t
pump effectively.
Cardiac Tamponade
✸ With poor pumping the
blood pressure starts to
drop.
✸ The heart rate starts to
increase to compensate
but is unable
✸ The patient’s level of
conscious drops, and
eventually the patient
goes in cardiac arrest
Cardiac Tamponade
● Signs and symptoms:
– Distended neck veins. The heart is so
compressed that it can’t circulate blood, and the
blood backups.
– Heart rate increases
– The respiratory rate increases
– Trachea is midline
– Lungs sound normal
Emergency Care of a Cardiac
Tamponade
✤ THIS IS A DIRE EMRGENCY!!!
✤ There is no field treatment - rapid transport

✪ Maintain an open airway


✪ High flow O2
✪ Control bleeding
✪ Notify medical control or the incoming ambulance of the situation
Injuries of the chest
➡ Pneumothorax - lungs
➡ Tension pneumothorax - lungs
➡ Massive hemothorax - lungs
➡ Flail Chest - skeleton and lungs
➡ Cardiac tamponade
➡ Transection of the Great Vessels
Transection of the Great vessels
Aortic Arch.
Transection of the Great vessels
The heart, more or less, just
hangs from the aortic arch
Much like a big pendulum.

If enough motion is placed on


the heart (i.e.. Deceleration
From a motor vehicle
accident, striking a tree while
skiing etc) the heart may tear
away from the aorta.
Transection of the Great vessels
The chances of survival are
very slim and are based on the
degree of the tear.

If there is just a small tear then


the patient may survive. If the
aorta is completely transected
then the patient will die
instantaneously
Transection of
the great vessels
♣Signs and symptoms:

♥ Burning and tearing sensation in the chest or back


♥ Rapidly dropping blood pressure
♥ Pulse will increase rapidly
♥ Rapid loss of consciousness
♥ Profound and uncorrectable shock. This patient
need to go straight to surgery
Transection of the great vessels
♣ Treatment:

♥ Rapid transport to the hospital for surgery is the


only answer
♥ Administer high flow O2
♥ Treat for shock

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