1 THORACIC TRAUMA 2 THORACIC TRAUMA 1 OUT

1 THORACIC TRAUMA

2 THORACIC TRAUMA 1 OUT OF 4 DEATHS

3 THORACIC INJURIES BLUNT: < 10% REQUIRE OPERATION PENETRATING: 15-30% REQUIRE OPERATION MAJORITY: SIMPLE PROCEDURES

4 PATHOPHISIOLOGY HYPOXIA: PO2 DECREASE HYPERCARBIA: PCO2 INCRESE ACIDOSIS

5 LIFE-THREATENING CHEST TRAUMA AIRWAY OBSTRUCTION TENSION PNEUMOTHORAX OPEN PNEUMOTHORAX MASSIVE HEMOTHORAX FLAIL CHEST CARDIAC TAMPONADE

6 TENSION PNEUMOTHORAX AIR ENTERS PLEURAL SPACE - NO EXIT. COLLAPSE OF AFFECTED LUNG IMPAIRED VENOUS RETURN IMPAIRED VENTILATION OF OPPOSITE LUNG

7

8 TENSION PNEUMOTHORAX ETIOLOGY POSITIVE PRESSURE VENTILATION (MOST COMMON) PARENCHYMAL AND / OR CHEST-WALL INJURIES

9 TRACHEAL DEVIATION RESPIRATORY DISTRESS UNILATERAL ABSENCE OF BREATH SOUNDS DISTENDED NECK VEINS CYANOSIS - LATE TRNSION PNEUMOTHORAX

10

11 TENSION PNEUMOTHORAX TREATMENT IMMEDIATE DECOMPRESSION CLINICAL DIAGNOSIS NOT RADIOLOGIC

12 OPEN PNEUMOTHORAX MANAGEMENT COVER DEFECT IMMEDIATELY CHEST TUBE DEFINITIVE OPERATION

13

14 MASSIVE HEMOTHORAX > 1500 ml BLOOD LOSE SYSTEMIC / PULMONARY VESSEL DISTENTION FLAT vs DISTENDED NECK VEINS SHOCK WITH NO BREATH SOUND AND/OR PERCUSSION DULNESS

15

17 MASSIVE HEMOTHORAX RAPID VOLUME RESTORE CHEST DECOMPRESSION AND ROENTGENOGRAM AUTO-TRANSFUSSION OPERATIVE INTERVENTION

18 FLAIL CHEST / PULMONARY CONTUSION TREATMENT

19 FLAIL CHEST / PULMONARY CONTUSION TREATMENT RE-EXPEND LUNG OXYGEN JUDICIOUS FLUID MANAGEMENT INTUBATION AS IDICATED ANALGESIA

20 FLAIL CHEST / PULMONARY CONTUSION TREATMENT

21 CARDIAC TAMPONADE

22 CARDIAC TAMPONADE ARTERIAL PESSURE DECREASE NARROWED PULSE PRESSURE DISTENDED NECK VEINS MUFFLED HEART SOUNDS C.V.P INCREASED

23 CARDIAC TAMPONADE TREATMENT PATENT AIRWAY I.V THERAPY PERICARDIOCENTESIS PERICARDIOTOMY

24 CARDIAC TAMPONADE TREATMENT PERICARDIOCENTESIS

25

26 SECONDARY SURVEY IN-DEPTH PHYSICAL EXAM UPRIGHT CHEST FILM ABGs ECG

27 POTENTIALLY LETHAL CHEST TRAUMA PULMONARY CONTUSION MYOCARDIAL CONTUSION AORTIC DISRUPTION TRAUMATIC DIAPHRAGMATIC RUPTURE TRACHEOBRONCHIAL DISRUPTION ESOPHAGEAL DISRUPTION

28 PULMONARY CONTUSION MOST COMMON SELECTIVE INTUBATION VENTILATE MAINTAIN ADEQUATE VENTILATE

29 Pulmonary Contusion

30 MYOCARDIAL CONTUSION BLUNT TRAUMA HISTORY ECG CHANGES 2-D ECHO TRAET COMPLICATION

31 TRAUMATIC AORTIC RUPTURE MOST COMMON CAUSE OF SUDDEN DEATH AUTO CRASH FALL FROM GREAT HEIGHT SALVAGE POSSIBLE IF IDENTIFIED EARLY COMMON SITE: LIGAMENTUM ARTERIOSUM

32 TRAUMATIC AORTIC RUPTURE

33 WIDENEND MEDIASTINUM ON ROENTGENOGRAM

34

35 TRAUMATIC AORTIC RUPTURE TREATMENT DIRECT REPAIR RESECTION AND GRAFTING TREATMENT BY QUALIFIED SURGEON

36 TRAUMATIC DIAPHRAGMATIC RUPTURE DIAGNOSED ON LEFT SIDE BLUNT => LARGE TEARS PENETRATING => SMALL PERFORATIONS MISINTERPRETED ROENTGENOGRAMS CONTRAST RADIOGRAPHY TREATMENT: OPERATION

37 TRACHEOBRONCHIAL INJURIES: LARYNX RARE OCCURANCE HOARSENESS, SUBCUTANEOUS EMPHYSEMA, PALPABLE FRACTURE TREATMENT: ITUBATION TRACHEOSTOMY

38 TRACHEOBRONCHIAL INJURIES: TRACHEA PARTIAL vs COMPLETE OBSTRUCTION ENDOSCOPY: DIAGNOSTIC AID TREATMENT: OPERATION

39 TRACHEOBRONCHIAL INJURIES: BRONCHUS FREQUENTLY MISSED BLUNT TRAUMA ENDOSCOPY: DIAGNOSTIC AID TREATMENT: AIRWAY MAINTAINANCE OPERATION

40 ESOPHAGEAL TRAUMA CHEST TUBE-PARTICULATE MATTER MEDIASTINAL AIR CONTRAST SWALLOW / ESOPHAGOSCOPY TREATMENT: OPERATION

41 ESOPHAGEAL TRAUMA BLUNT vs PENETRATING SEVER EPIGASTRIC BLOW SHOCK / PAIN > INJURY PNEUMOTHORAX WITHOUT FRACTURE

42 SUBCUTANEOUS EMPHYSEMA AIRWAY INJURY PNEUMOTHORAX BLAST INJURY

43 SIMPLE PNEUMOTHORAX BLUNT vs PENETRATING TRAUMA VENTILATION/PERFUSSION DEFECT HYPER-RESONANCE DECREASED BREATH SOUNDS TREATMENT: TUBE-THORACOTOMY

44 PNEUMOTHORAX ETIOLOGY LUNG/VESSEL LACERATION TREATMENT: TUBE-THORACOTOMY

45 RIB FRACTURES PAIN/SPLINTING IMPAIRED VENTILATION INCREASED SECRETIONS ATHELECTASIS/PNEUMONIA

46 SCAPULAR AND RIB FRACTURES SCAPULA AND RIBS 1-3 SEVERE FORCE ASSOCIATED INJURIES HIGH MORTALITY RISK

47 RIB FRACTURES RIBS 4-9 MAJORITY BLUNT TRAUMA MIDSHAFT FRACTURE INTRATHORACIC INJURY RIBS 10-12 SUSPECT ABDOMINAL INJURY

48 RIB FRACTURES CHEST FILM: EXCLUDE INTRATHORACIC INJURY NO CONSTRICTIVE DEVICE ADEQUATE PAIN RELIEF

49 OTHER INDICATION FOR TUBE THORACOSTOMY SUSPECTED SEVERE LUNG INJURY AIR OR GROUND TRANSFER GENERAL AESTHESIA POSITIVE PRESSURE VENTILATION

50 QUESTIONS ???