Trauma to the chest are some of the most
life-threatening conditions that present to
the ED.
 Acceleration and Deceleration forces are a
common cause of intrathoracic injury.
 Most common type of injury is blunt trauma
resulting from MVC.
 Isolated injury is uncommon-frequently
associated with head, abdomen, or
extremity injury as well.
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Ineffective ventilate can occur due to
structural injury, pain, inability to maintain
negative intrapleural pressure.
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Inury to thoracic vessels can cause
hemorrhage and shock.
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Air and blood can accumulate in the
thoracic cavity increasing intrapleural
pressure which might cause the heart and
vessels to shift or occlude.
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A fracture of two or more sites on two or
more adjacent ribs, or when rib fractures
produce a free- floating sternum.
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Movement of the chest wall is
paradoxical during inspiration and
expiration.
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Injury to the chest results in accumulation of air in the
pleural space with the subsequent loss of the
negative intarpleural pressure. This can result in
partial or complete collapse of the lung.
An open pneumothorax results from a wound
through the chest wall that allow air to enter the
pleural space both from the wound and the
trachea.
Tension Pneumothorax allows air to enter the pleural
space on inspiration, but air cannot escape on
expiration. Rising pressure causes collapse of the
lung and a mediastinal shift that compresses the
heart, vessels, trachea, and unaffected lung.
Accumulation of blood in the pleural
space.
 Hemorrhage can occur causing
mediastinal shift, hypotension.
 Indications for surgery:

› Volume of blood drained
› Continued blood loss > 200 ml/he in first two
hours.
› Hemodynamic stability
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Simple Pneumothorax-Chest tube insertion
(Thoracostomy) If pneumo < 25% may be deferred
unless needs air transport. Insertion site 4th or 5th
intercostal space anterior to midaxillary line.
Open Pneumothorax-Cover wound with a sterile non
porous dressing, taped securely on three sides.
Hemothorax-Chest Tube Insertion, be prepared for
large quantity of blood
Tension Pneumothorax-Immediate Needle
decompression (Thoracentesis) 14 gauge needle in
2nd intercostal space midclavicular on the affected
side.
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Assessment of chest tube: FOCA
›
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F Fluctuation in the water seal chamber
O Output
C Color
A Air leak
● Trouble shooting for problems with tubes: DOPE
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D – Dislodgement
O – Obstruction
P – Pneumothorax
E - Equipment
Potentially life threatening-Either from
penetrating or blunt trauma
 Left side is more common as right is
protected from the liver.
 Herniation of abdominal contents can
occur into the thorax.
 Herniation results in respiratory
compromise.

Collection of blood in the pericardial
sac.
 Accumulation of blood exerts pressure
on heart with inhibits the ventricles ability
to fill.

Result from blunt or penetrating trauma
 There is an 85% mortality prior to arrival at
a hospital. From those admitted and
who received surgical intervention, an
additional 10% to 30% will die.
 MOI is a combination of shearing and
deceleration.

“Cardiac Contusion”
 Suspect if associated MOI or has a poor
cardiovascular response.
 Injuries may range from petechiae to fullthickness contusions to rupture of the
heart
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