Thoracic-trauma
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THORACIC TRAUMA
YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!
INTRODUCTION •
Each year there are nearly 150,000 accidental deaths in the United States
•
25% of these deaths are a direct result of thoracic trauma
•
An additional 25% of traumatic deaths have chest injury as a contributing factor
MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS 100 90 80 70 60 Total 50 Wounded 40 30 20 10 0
79% 63% 56% 25% 12% % Chest Wound Related Deaths
Crimean War (18531856) American Civil War (1861-1865) Franco-Prussian War (1870-1871) World War I (19141918) World War II (19391945)
REASON As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!
Major Anatomy and Physiology of the Chest
OVERVIEW •
Causes of Thoracic Trauma
•
Types, Signs and Symptoms, and Management of Thoracic Trauma
CAUSES OF THORACIC TRAUMA: •
Falls 3
•
• •
times the height of the patient Blast Injuries overpressure, plasma forced into alveoli Blunt Trauma PENETRATING TRAUMA
OPEN PNEUMOTHORAX •
Develops when penetration injury to the chest allows the pleural space to be exposed to atmospheric pressure - “Sucking Chest Wound”
•
Q- WHAT MAY CAUSE A SCW?
•
Examples Include: GSW, Stab Wounds, Impaled Objects, Etc...
LARGE VS SMALL •
Severity is directly proportional to the size of the wound
•
Atmospheric pressure forces air through the wound upon inspiration
S/S: OPEN PNEUMOTHORAX •
Shortness of Breath (SOB)
•
Pain
•
Sucking or gurgling sound as air moves in and out of the pleural space through the wound
MANAGEMENT OF SCW •
Apply an Asherman Chest Seal Occlusive dressing with a release valve
•
Observe for development of a
Tension Pneumothorax
TENSION PNEUMOTHORAX •
Air within thoracic cavity that cannot exit the pleural space
•
Fatal if not immediately identified, treated, and reassessed for effective management
Tension Pneumothorax Following Stab Wound
EARLY S/S OF TENSION PNEUMOTHORAX •
ANXIETY!
•
Increased respiratory distress
•
Unilateral chest movement
•
Unilateral decreased or absent breath sounds
LATE S/S OF TENSION PNEUMOTHORAX •
Jugular Venous Distension (JVD)
•
Tracheal Deviation
•
Narrowing pulse pressure
•
Signs of decompensating shock
JVD & TRACHEAL SHIFT Decreased input and output from the heart with compression of the great vessels
JVD & TRACHEAL SHIFT Increased pressure moves mediastinum and compresses the lung on the uninjured side
MANAGEMENT OF TENSION PNEUMOTHORAX •
Asherman Chest Seal
•
Needle Decompression
•
High flow oxygen (If available)
•
Bag Valve Mask / Intubation
•
Chest Tube (BN CCP/CASEVAC)
RGR MEDIC CHEST TUBE INSERTION
NEEDLE THORACENTESIS •
Locate 2nd or 3rd Intercostal Space at the Midclavicular Line
•
Insert a 14g needle/catheter over the top of the rib (“VAN”) into the pleural space
•
Listen for air escape (WHOOSH!)
•
Leave the catheter in place
•
Reassess
NEEDLE THORACENTESIS
NEEDLE THORACENTESIS
SUMMARY • • •
Reviewed anatomy and physiology of the chest Discussed causes of trauma to the chest Signs, symptoms, and emergent management of: OPEN
PNEUMOTHORAX Asherman Chest Seal
TENSION
PNEUMOTHORAX Needle Thoracentesis
QUESTIONS?
YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!
INTRODUCTION •
Each year there are nearly 150,000 accidental deaths in the United States
•
25% of these deaths are a direct result of thoracic trauma
•
An additional 25% of traumatic deaths have chest injury as a contributing factor
MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS 100 90 80 70 60 Total 50 Wounded 40 30 20 10 0
79% 63% 56% 25% 12% % Chest Wound Related Deaths
Crimean War (18531856) American Civil War (1861-1865) Franco-Prussian War (1870-1871) World War I (19141918) World War II (19391945)
REASON As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!
Major Anatomy and Physiology of the Chest
OVERVIEW •
Causes of Thoracic Trauma
•
Types, Signs and Symptoms, and Management of Thoracic Trauma
CAUSES OF THORACIC TRAUMA: •
Falls 3
•
• •
times the height of the patient Blast Injuries overpressure, plasma forced into alveoli Blunt Trauma PENETRATING TRAUMA
OPEN PNEUMOTHORAX •
Develops when penetration injury to the chest allows the pleural space to be exposed to atmospheric pressure - “Sucking Chest Wound”
•
Q- WHAT MAY CAUSE A SCW?
•
Examples Include: GSW, Stab Wounds, Impaled Objects, Etc...
LARGE VS SMALL •
Severity is directly proportional to the size of the wound
•
Atmospheric pressure forces air through the wound upon inspiration
S/S: OPEN PNEUMOTHORAX •
Shortness of Breath (SOB)
•
Pain
•
Sucking or gurgling sound as air moves in and out of the pleural space through the wound
MANAGEMENT OF SCW •
Apply an Asherman Chest Seal Occlusive dressing with a release valve
•
Observe for development of a
Tension Pneumothorax
TENSION PNEUMOTHORAX •
Air within thoracic cavity that cannot exit the pleural space
•
Fatal if not immediately identified, treated, and reassessed for effective management
Tension Pneumothorax Following Stab Wound
EARLY S/S OF TENSION PNEUMOTHORAX •
ANXIETY!
•
Increased respiratory distress
•
Unilateral chest movement
•
Unilateral decreased or absent breath sounds
LATE S/S OF TENSION PNEUMOTHORAX •
Jugular Venous Distension (JVD)
•
Tracheal Deviation
•
Narrowing pulse pressure
•
Signs of decompensating shock
JVD & TRACHEAL SHIFT Decreased input and output from the heart with compression of the great vessels
JVD & TRACHEAL SHIFT Increased pressure moves mediastinum and compresses the lung on the uninjured side
MANAGEMENT OF TENSION PNEUMOTHORAX •
Asherman Chest Seal
•
Needle Decompression
•
High flow oxygen (If available)
•
Bag Valve Mask / Intubation
•
Chest Tube (BN CCP/CASEVAC)
RGR MEDIC CHEST TUBE INSERTION
NEEDLE THORACENTESIS •
Locate 2nd or 3rd Intercostal Space at the Midclavicular Line
•
Insert a 14g needle/catheter over the top of the rib (“VAN”) into the pleural space
•
Listen for air escape (WHOOSH!)
•
Leave the catheter in place
•
Reassess
NEEDLE THORACENTESIS
NEEDLE THORACENTESIS
SUMMARY • • •
Reviewed anatomy and physiology of the chest Discussed causes of trauma to the chest Signs, symptoms, and emergent management of: OPEN
PNEUMOTHORAX Asherman Chest Seal
TENSION
PNEUMOTHORAX Needle Thoracentesis
QUESTIONS?
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