外科学教学课件：Chest Trauma

1、Chest Trauma,Introduction,Chest trauma is often sudden and dramatic. Accounts for 25%of all trauma deaths 2/3 of deaths occur after reaching hospital. Over 70% of thoracic injuries result from blunt trauma, most of which are caused by automobile accidents. Serious pathological consequnces: -hypoxia,

2、 hypovolaemia, myocardial failure.,Classification and pathophysiology,Penetrating injuries: E.g. stab wounds ect. Primarily peripheral lung. Haemothorax. Pneumothorax. Cardiac, great vessel or esophageal injury.,Classification and pathophysiology,Blunt injuries: Either: -direct blow (e.g. rib fractu

3、re) -deceleration injury or -compression injury Rib fracture is the most common sign of blunt chest trauma. Fracture of scapula, sternum, or first rib suggests massive force of injury.,Ongoing intrathoracic hemorrhage. Injury of heart or large vessels. Serious injuries of lung, trachea, bronchus. Ru

4、pture of esophagus. Massive loss of chest wall. Foreign body in chest.,Indications for emergency thoracotomy,Indications for emergency department thoracotomy,Unresponsive hypotension (SBP 1500 ml) Traumatic arrest with previously witnessed cardiac activity (prehospital or in-hospital) after penetrat

5、ing thoracic injuries Persistent hypotension (SBP 60 mm Hg) with diagnosed cardiac tamponade, air embolism,Rib fractures,Most common blunt thoracic injury. 4th-7th ribs are longer and fixed, so they are easy to be broken. Symptoms include localised pain, exquisite tenderness, and possibly crepitus.

6、CXR to exclude other injuries. Upper ribs, clacicle or scapula fracture:suspect vascular injury.,Rib fractures,Analgesia-avoid taping. The modern approach to treatment emphasizes relief of pain, prevention of atelectasis, and optimization of pulmonary toilet.,Flail chest,Multiple rib fractures produ

7、ce a mobile fragment which moves paradoxically with respiration. Results with the fracture of four or more ribs at two sites either unilaterally or bilaterally. This impairs respiratory mechanics, resulting in hypoventilation, poor pulmonary drainage, and atelectasis.,Flail Chest,Conservative therap

8、y, with emphasis on pain relief. In a minority of cases patients require chest wall stabilization.,Pneumothorax,Pneumothorax is commonly known as a collapsed lung. A collection of air or gas in the pleural space. Close pneumothorax, open pneumothorax, tension pneumothorax,Close Pneumothorax,Air ente

9、rs into the intrapleural space with preceding blunt trauma and without open wound. The lung collapses: 30% Sudden, sharp chest pain Shortness of breath Chest tightness CRX Treatment: 30% needle aspiration, chest tube,Open Pneumothorax,Occurs when there is a pneumothorax associated with a chest wall

10、defect. Air enters into the chest cavity not through the trachea but through the hole in the chest wall. Wound coverage/Chest tube,Wound coverage/Chest tube,Tension pneumothorax,A tension pneumothorax is a complete collapse of the lung. It occurs when air enters, but does not leave, the space around

11、 the lung (pleural space).,Tension pneumothorax,As the amount of trapped air increases, pressure builds up in the chest. The lung collapses on that side and can push the important structures in the center of the chest (such as the heart, major blood vessels, and airways) toward the other side of the

12、 chest. The shift can cause the other lung to become compressed, and can affect the flow of blood returning to the heart. This situation can lead to low blood pressure, shock, and death.,Tension pneumothorax,Tension pneumothorax,Symptoms of a tension pneumothorax may include: Shift of the trachea Lo

13、ss of consciousness Sweating Gasping Shock Rapid HR,Tension pneumothorax,Tension pneumothorax,When heard through a stethoscope, the breath sounds are decreased. Structures in the center of the chest (mediastinum) may appear to have moved. There may be air trapped in the tissue of the chest wall (sub

14、cutaneous emphysema), causing a spongy feeling when the chest is felt with the hands (palpation) In general, if a health care provider suspects tension pneumothorax, treatment should start before tests are done. Some tests can help confirm the diagnosis and determine the severity of the problem.,Ten

15、sion pneumothorax,If you have symptoms of tension pneumothorax, get immediate medical treatment. Treatment removes the air from the pleural space, allowing the lung to re-expand. In an emergency, a small needle (such as a standard intravenous needle) may be placed into the chest cavity through the r

16、ibs to relieve pressure.,Tension pneumothorax,The standard treatment is a chest tube, a large plastic tube that is inserted through the chest wall between the ribs to remove the air. The chest tube is attached to a vacuum bottle that slowly removes air from the chest cavity. This allows the lung to

17、re-expand. As the lung heals and stops leaking air, the vacuum is turned down and then the chest tube is removed. Some people might need to stay in the hospital to have the chest tube checked, and because it can take several days for the affected lung to fully re-expand.,Tension pneumothorax,Chest Tubes,Hemothorax,Massive hemothorax,Hemothorax,Blood can also collect in the pleural space and cause all the same signs and symptoms and problems as a pneumothorax including a tension hemothorax A small hemothorax may