Presentation is loading. Please wait.

Presentation is loading. Please wait.

International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Thoracic Trauma 6.

Similar presentations


Presentation on theme: "International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Thoracic Trauma 6."— Presentation transcript:

1 International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Thoracic Trauma 6

2 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Thoracic Trauma © Pearson

3 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Major signs and symptoms –Immediate life-threatening injuries Pathophysiology and management –Open pneumothorax –Tension pneumothorax –Massive hemothorax –Flail chest –Cardiac tamponade

4 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Cardiac involvement with blunt injury Other thoracic injuries

5 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Thoracic Trauma Thoracic injury is common –50% of multiple trauma –25% of trauma deaths Potentially fatal thoracic injuries saved by rapid recognition and intervention –Many require surgical intervention

6 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Chest Anatomy

7 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Mechanism of Injury Blunt –Direct compression  Fracture of solid organs  Blowout of hollow organs –Deceleration forces  Tearing of organs and blood vessels Penetrating –Direct trauma to organ and vasculature –Energy transmitted from mass and velocity

8 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Tissue Hypoxia Inadequate oxygen delivery Hypovolemia Ventilation/perfusion mismatch Pleural pressure changes Pump failure

9 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Thoracic Trauma Signs and symptoms –Shortness of breath –Chest pain –Hemoptysis –Cyanosis –Neck veins distended –Tracheal deviation –Asymmetrical movement –Chest wall contusion –Open wounds –Subcutaneous emphysema –Shock –Tenderness, instability, crepitation (TIC) –Breath sounds abnormal

10 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Primary Survey “Deadly Dozen” 1.Airway obstruction 2.Flail chest 3.Open pneumothorax 4.Massive hemothorax 5.Tension pneumothorax 6.Cardiac tamponade

11 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Secondary Survey “Deadly Dozen” 7.Myocardial contusion 8.Traumatic aortic rupture 9.Tracheal or bronchial tree injury 10.Diaphragmatic tears 11.Pulmonary contusion 12.Blast injuries

12 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Airway obstruction –Secondary hypoxia  Common cause of preventable death  Foreign body, tongue, aspiration –Always assume cervical spine injury

13 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Flail chest

14 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Flail chest –Assist ventilation –Possible intubation –Load-and-go –Stabilize flail segment –Monitor for:  Pulmonary contusion  Hemothorax  Pneumothorax (Courtesy of Stanley Cooper, EMT-P )

15 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Open pneumothorax –“Sucking chest wound”  Air enters pleural space  Ventilation impaired  Hypoxia results –Signs and symptoms  Proportional to size of defect

16 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Open pneumothorax –Close chest wall defect –Load-and-go Above photo courtesy of Teleflex Incorporated, all rights reserved. No other use shall made of the image without the prior written consent of Teleflex Incorporated.

17 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Massive hemothorax –Anxiety and confusion –Neck veins  Flat: hypovolemia  Distended: mediastinal compression –Breath sounds decreased  Dull if percussed –Shock

18 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Massive hemothorax –Load-and-go –Treat for shock –Fluid administration  Titrate to peripheral pulse (80-90 mmHg) –Monitor for:  Tension hemopneumothorax

19 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Tension pneumothorax –Dyspnea –Anxiety –Tachypnea –Distended neck veins –Tracheal deviation (rare) –Breath sounds diminished  Hypertympany if percussed –Shock with hypotension

20 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Tension pneumothorax –Decompress affected side  Respiratory distress and cyanosis  Loss of radial pulse  Decreasing level of consciousness –Load-and-go (Courtesy of Louis B. Mallory, MBA, REMT-P)

21 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Cardiac tamponade –Beck's triad  Hypotension  Neck veins distended  Heart sounds muffled –Paradoxical pulse –Breath sounds equal

22 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Primary “Deadly Dozen” Cardiac tamponade –Load-and-go –Treat for shock –Fluid administration  Titrate to peripheral pulse (80–90 mmHg) –Monitor and treat dysrhythmias –Monitor for:  Hemothorax  Pneumothorax

23 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Secondary “Deadly Dozen” Myocardial contusion –Most common cardiac injury  Blunt anterior chest injury –Same as myocardial infarction  Chest pain  Dysrhythmias  Cardiogenic shock (rare) –Treat as cardiac tamponade

24 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Secondary “Deadly Dozen” Traumatic aortic rupture –Most common cause of immediate death  Motor-vehicle collisions or falls from heights  80% die immediately –Scene Size-up and history extremely important  No obvious sign of chest trauma  Hypertension in upper extremities and hypotension in lower extremities (rare)

25 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Secondary “Deadly Dozen” Tracheal or bronchial tree injury –Subcutaneous emphysema  Chest, face, neck –Ensure adequate airway  Cuffed ET tube past site of injury –Monitor for:  Pneumothorax  Hemothorax

26 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Secondary “Deadly Dozen” Diaphragmatic tear –Severe blow to abdomen –Herniation of abdominal organs  More common on left  Breath sounds diminished  Bowel sounds auscultated in chest (rare)  Abdomen appears scaphoid

27 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Secondary “Deadly Dozen” Pulmonary contusion –Common from blunt trauma –Hours to develop –Marked hypoxemia

28 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Secondary “Deadly Dozen” Blast injury –Penetrating trauma –Difficult to assess in field –If unrecognized, may be lethal

29 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Other Chest Injuries Impaled objects –Do not remove –Stabilize the object –Monitor for:  Tension pneumothorax  Hemothorax  Cardiac tamponade

30 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Other Chest Injuries Traumatic asphyxia –Severe compression –Ruptures capillaries  Cyanosis above crush  Swelling of head, neck  Swollen tongue, lips  Conjunctival hemorrhage Courtesy of John Campbell

31 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Other Chest Injuries Simple pneumothorax –Fractured ribs –Pleuritic chest pain –Dyspnea –Decreased breath sounds –Hypertympany if percussed –Monitor for:  Tension pneumothorax

32 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Other Chest Injuries Sternal fracture –Significant blunt trauma to anterior chest –Signs of fracture on palpation –Myocardial contusion presumed Simple rib fracture –Most frequent chest injury –Monitor for:  Pneumothorax  Hemothorax

33 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Summary Chest injuries common Often life-threatening –Require prompt recognition –Require prompt intervention –Frequently require load-and-go Airway and oxygenation always priority Frequent Ongoing Exams


Download ppt "International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Thoracic Trauma 6."

Similar presentations


Ads by Google