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THORACIC TRAUMA. YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!

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Presentation on theme: "THORACIC TRAUMA. YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!"— Presentation transcript:

1 THORACIC TRAUMA

2 YOU JUST NEVER KNOW WHEN TRAUMA WILL OCCUR!

3 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

4 MORTALITY OF CHEST WOUNDS DURING MILITARY CAMPAIGNS

5 REASON As a Ranger First Responder, you must be able to identify and treat penetrating trauma to the chest!

6 Major Anatomy and Physiology of the Chest

7 OVERVIEW Causes of Thoracic Trauma Types, Signs and Symptoms, and Management of Thoracic Trauma

8 CAUSES OF THORACIC TRAUMA: Falls  3 times the height of the patient Blast Injuries  overpressure, plasma forced into alveoli Blunt Trauma PENETRATING TRAUMA

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10 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...

11 LARGE VS SMALL Severity is directly proportional to the size of the wound Atmospheric pressure forces air through the wound upon inspiration

12 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

13 MANAGEMENT OF SCW Apply an Asherman Chest Seal  Occlusive dressing with a release valve Observe for development of a Tension Pneumothorax

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16 TENSION PNEUMOTHORAX Air within thoracic cavity that cannot exit the pleural space Fatal if not immediately identified, treated, and reassessed for effective management

17 Tension Pneumothorax Following Stab Wound

18 EARLY S/S OF TENSION PNEUMOTHORAX ANXIETY! Increased respiratory distress Unilateral chest movement Unilateral decreased or absent breath sounds

19 LATE S/S OF TENSION PNEUMOTHORAX Jugular Venous Distension (JVD) Tracheal Deviation Narrowing pulse pressure Signs of decompensating shock

20 JVD & TRACHEAL SHIFT Decreased input and output from the heart with compression of the great vessels

21 JVD & TRACHEAL SHIFT Increased pressure moves mediastinum and compresses the lung on the uninjured side

22 MANAGEMENT OF TENSION PNEUMOTHORAX Asherman Chest Seal Needle Decompression High flow oxygen (If available) Bag Valve Mask / Intubation Chest Tube (BN CCP/CASEVAC)

23 RGR MEDIC CHEST TUBE INSERTION

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25 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

26 NEEDLE THORACENTESIS

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28 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

29 QUESTIONS?


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