MAGEN
DAVID
ADOM
IN ISRAEL
@
Thoracic
Trauma
‫מגן דוד‬
‫אדום‬
‫בישראל‬
Objectives
MAGEN
DAVID
ADOM
IN ISRAEL
@
n
Review the anatom y ofthe chest.
o
D iscuss the m echanics ofbreathing.
p
D etailthe assessm entprocess.
q
Coverthe m anagem entofrib fractures,
flailchest,pulm onary contusion,
pneum othorax,tension pneum othorax,
m yocardialcontusion,pericardial
tam ponade,aortic rupture and traum atic
asphyxia.
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Introduction
MAGEN
DAVID
ADOM
IN ISRAEL
@
⎜ Chest injuries are the second leading
cause of trauma deaths each year.
⎜ Chest injuries often go unrecognized.
⎜ Missed injuries result in inadequate
ventilation, hypoxia and hypercarbia.
⎜ Our goal is to find these injuries early
and treat them aggressively.
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Anatomy
⎜ Major structures in the thorax:
Trachea.
Bronchi.
Lobes of the lungs.
Heart.
Aorta.
Vena cava.
Esophagus.
MAGEN
DAVID
ADOM
IN ISRAEL
@
‫מגן דוד‬
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Physiology
MAGEN
DAVID
ADOM
IN ISRAEL
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‫מגן דוד‬
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What happens to the chest on inspiration and expiration?
How does air move into and out of the chest?
Gas Exchange in the Lungs
MAGEN
DAVID
ADOM
IN ISRAEL
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‫מגן דוד‬
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Assessment of Chest Trauma
MAGEN
DAVID
ADOM
IN ISRAEL
@
⎜ The initial assessment should serve
to detect most major chest injuries.
⎜ The kinematics of the event will
point to most major chest trauma.
⎜ Pain from chest trauma tends to be
provoked by deep inspiration and/or
firm palpation.
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Assessment
MAGEN
DAVID
ADOM
IN ISRAEL
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‫מגן דוד‬
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⎜ Observation
What are we looking for?
⎜ Palpation
Why are we feeling the chest?
⎜ Auscultation
What are we listening for in the chest?
Chest Trauma
MAGEN
DAVID
ADOM
IN ISRAEL
@
⎜ Chest trauma falls into two categories,
based on mechanism of injury.
Penetrating.
Blunt.
Can you name some
mechanisms of injury for each?
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Scenario
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DAVID
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You are responding to a call to the police
station, where a 19-year-old male
patient is complaining of chest pain.
Upon arrival, you learn that your patient
was kicked in the chest during a fight.
What injuries does the mechanism suggest?
Findings
MAGEN
DAVID
ADOM
IN ISRAEL
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‫מגן דוד‬
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Θ A - Clear.
Θ B - Left-sided chest pain during
inspiration; BS equal.
Θ C - Normal pulse; no external bleeding.
Θ D - Alert, oriented x 3.
Θ Vitals: Pulse 98, RR 26, BP 122/74.
Given the findings, what injuries can you rule out?
How should this patient be managed?
Scenario
MAGEN
DAVID
ADOM
IN ISRAEL
@
You are called to a farm for a worker who has
fallen from a hay loft and impaled himself on a
post. On arrival, you see him lying on the
ground in obvious respiratory distress. The
scene appears safe.
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Findings
MAGEN
DAVID
ADOM
IN ISRAEL
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‫מגן דוד‬
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Θ A - Clear.
Θ B - Rapid, paradoxical movement of the
right chest. BS diminished on that side.
Θ C - Rapid radial pulse.
Θ D - Alert, oriented x3.
Θ Vitals: Pulse 118, RR 38, BP 106/80.
Given the findings, what injuries do you suspect?
How should this patient be managed?
MAGEN
DAVID
ADOM
IN ISRAEL
@
Scenario
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You respond to the aid of a 16-year-old male
gunshot victim. Police inform you that the
weapon was a .22-caliber handgun.
What do you know
about .22-caliber
bullets?
Findings
MAGEN
DAVID
ADOM
IN ISRAEL
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‫מגן דוד‬
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Θ A-
Clear.
Θ B-
Fast. BS diminished on right. Entrance
wound noted in right anterior chest wall.
Θ C-
Pulse rapid. No external bleeding noted.
Θ D - Alert, oriented x3.
Θ Vitals: Pulse 114, RR 32, BP 108/78.
What is your major concern for this patient?
Scenario
MAGEN
DAVID
ADOM
IN ISRAEL
@
You respond to an industrial incident
where a 48-year-old male has fallen 15
feet from some scaffolding and landed
on some equipment. On your arrival,
you find him complaining of chest pain
and difficulty breathing.
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Findings
MAGEN
DAVID
ADOM
IN ISRAEL
@
‫מגן דוד‬
‫אדום‬
‫בישראל‬
Θ A - Clear.
Θ B - Rapid, shallow; speaking in 2-3
word bursts. BS absent on left. Pain on
palpation of left chest. JVD noted.
Θ C - Rapid, weak pulse. No external
bleeding noted.
Θ D - Alert, oriented x3.
What are this patient’s problems?
What are your treatment priorities?
MAGEN
DAVID
ADOM
IN ISRAEL
@
Tension vs. Simple Pneumothorax
⎜ Simple pneumothorax.
Decreased or absent breath sounds.
Mechanism of injury.
⎜ Tension pneumothorax.
Decreased or absent breath sounds.
Mechanism of injury.
Hemodynamic compromise.
‫מגן דוד‬
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Scenario
MAGEN
DAVID
ADOM
IN ISRAEL
@
‫מגן דוד‬
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Your patient is a 37-year-old female who was
involved in a head-on MVC. Looking at the car,
you surmise that this was a high-energy impact.
The patient has been extricated on your arrival.
Findings
MAGEN
DAVID
ADOM
IN ISRAEL
@
Θ A-
Clear.
Θ B-
RR slightly elevated. BS clear. Bruising
over sternum.
Θ C-
Pulse irregular. No external bleeding.
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Θ D - Alert, oriented x3.
Θ Vitals: Pulse 88 & irregular, RR 20, BP 132/80.
What is this patient’s problem?
How would you treat her?
Thoracic Trauma Summary
MAGEN
DAVID
ADOM
IN ISRAEL
@
Because the thoracic cavity
contains the vital organs that
oxygenate and distribute blood to
the rest of the body, timely
recognition and treatment of chest
injuries results in better patient
outcomes.
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