Trauma Toraks

Michael Mulyono
Olivia Petrina
Adityo Baskoro
Dani Yudo
 Classification
Penetrating Trauma
<20-30% memerlukan torakotomi
Blunt Trauma
<10% memerlukan torakotomi
 Penetrating Trauma
Pneumothorax
Open
Closed (Simple and Tension)
Hematothorax
Hematopneumothorax
Vascular laceration
Tracheo-bronchial Rupture
Oesophagial Rupture
Cardiac penetrating wound
Tamponade
Diaphraghm Rupture
 Blunt Trauma
Rib Fracture
Multiple Rib
Flail Chest
Visceral Damage
Pulmonary Contusion
Pneumothorax
Hematothorax
Traumatic Asphyxia
 Major Death Cause
Airway Obstruction
Hypovolemia
Cardiac Tamponade
 Tension Pneumothorax
Develops when a one-way valve air leak
occurs.
Air forced into the thoracic cavity without
means of escaping
Will cause:
Collapse of affected lung
Displaced mediastinum reduce VR
Compressing opposite lung
 Clinical Manifestation
Dyspnea Diminished then absent
Tachypnea at first breath sounds on injured
Progressive side
ventilation/perfusion Cyanosis
mismatch
Atelectasis on uninjured side Diaphoresis
Hypoxemia JVD
Hyperinflation of injured side Hypotension
of chest Hypovolemia
Hyperresonance of injured
side of chest Tracheal Shifting
LATE SIGN
 Management
Immediate
decompression
needle thoracostomy at
2nd intercostal space,
mid-clavicular line
Definitive treatment:
insertion of chest tube
into fifth intercostal
space, between the
anterior and midaxillary
line
 Open Pneumothorax
Sucking chest wound
Large defects of the
chest wall causing
immediate
equilibration between
intrathoracic presure
and atmospheric
pressure
Involve defects of
more than two-thirds
the diameter of trachea
(Normal 1.0-1.5cm)
 Management:
Closing defect with sterile
occlusive dressing and
taped on 3 sides
Open end of the dressing
allows air to escape
A chest tube should be
placed as soon as
possible
Definitive: surgical closure
of defect
 Hematothorax
Accumulation of blood in the pleural space
Serious hemorrhage may accumulate 1,500
mL of blood
Mortality rate of 75%
Each side of thorax may hold up to 3,000 mL
Blood loss in thorax causes a decrease in
tidal volume
Ventilation/Perfusion Mismatch & Shock
Typically accompanies pneumothorax
Hemopneumothorax
Management :
High flow O2
2 large bore IVs
Maintain SBP of 90-100
EVALUATE BREATH SOUNDS for fluid overload
Chest Tube Insertion
Consider thoracotomy
 Clinical Manifestation
Shock
Dyspnea
Tachycardia
Tachypnea
Diaphoresis
Hypotension
Dull to percussion over injured side
 Flail Chest
Occurs when a
segment of the chest
wall doesnt have bony
continuity with the rest
of the thoracic cage

Multiple rib fractures

Two or more ribs
fractured in two or more
places
 Features:
Paradoxical motion of
chest wall
Pain
Restricted chest wall
movement
Hypoventilation
Worsening hypoxia
CXR
ABG respiratory
failure
 Definitive treatment
Reexpand the lung
Ensure oxygenation
Fixation
Internal
External (Wide Plaster)
Provide analgesia to improve ventilation
 Pulmonary Contusion
Soft tissue contusion of the lung
30-75% of patients with significant blunt chest trauma
Frequently associated with rib fracture
Typical MOI
Deceleration
Chest impact on steering wheel
Bullet Cavitation
High velocity ammunition
Microhemorrhage may account for 1- 1 L of blood
loss in alveolar tissue
Progressive deterioration of ventilatory status
Hemoptysis typically present
 Pericardiac Tamponade
Restriction to cardiac filling caused by blood
or other fluid within the pericardium
Occurs in <2% of all serious chest trauma
However, very high mortality
Results from tear in the coronary artery or
penetration of myocardium
Blood seeps into pericardium and is unable to
escape
200-300 ml of blood can restrict effectiveness of
cardiac contractions
Removing as little as 20 ml can provide relief
 Clinical Manifestation
Dyspnea Kussmauls sign
Possible cyanosis Decrease or absence of
JVD during inspiration
Becks Triad Pulsus Paradoxus
JVD Drop in SBP >10 during
inspiration
Distant heart tones
Due to increase in CO2
Hypotension or narrowing during inspiration
pulse pressure Electrical Alterans
Weak, thready pulse P, QRS, & T amplitude
changes in every other
Shock cardiac cycle
PEA
 Management :
High flow O2
IV therapy
Consider pericardiocentesis; rapidly
deteriorating patient
 Tracheobronchial Injury
50% of patients with injury die within 1 hr of injury
Disruption can occur anywhere in tracheobronchial
tree
Signs & Symptoms
Dyspnea
Cyanosis
Hemoptysis
Massive subcutaneous emphysema
Suspect/Evaluate for other closed chest trauma
Management :
Support therapy
Keep airway clear
Administer high flow O2
Consider intubation if unable to maintain patient
airway
Observe for development of tension pneumothorax
and SQ emphysema
 Traumatic Asphyxia
Results from severe compressive forces applied to
the thorax
Causes backwards flow of blood from right side of
heart into superior vena cava and the upper
extremities
Signs & Symptoms
Head & Neck become engorged with blood
Skin becomes deep red, purple, or blue
NOT RESPIRATORY RELATED
JVD
Hypotension, Hypoxemia, Shock
Face and tongue swollen
Bulging eyes with conjunctival hemorrhage
 Support airway
Provide O2
PPV with BVM to assure adequate ventilation
2 large bore IVs
Evaluate and treat for concomitant injuries
If entrapment > 20 min with chest
compression
Consider 1mEq/kg of Sodium Bicarbonate
Thank You =)