CHEST TRAUMA

 Approximately 60% of all multi system trauma victims have some type of chest
or thoracic trauma. Chest trauma is classified as either BLUNT or
PENETRATING
 2/3 of deaths occur after reaching hospital
 Serious pathological consequnces:
-hypoxia, hypovolaemia, myocardial failure

Classification of Chest Trauma

1. Blunt chest trauma is more common, It results from sudden compression or

positive pressure inflicted to the chest wall. Motor vehicle crashes, falls, and
bicycle crashes are the most common causes.

2. Penetrating trauma occurs when a foreign object penetrates the chest wall. Gun
shot wound and Stabbing are the most common causes

BLUNT TRAUMA include the:

1. Sternal and Rib Fractures,

STERNAL FRACTURES
common in vehicle crashes with direct blow to the sternum via the steering
wheel.

RIB FRACTURES
Injury at the first 3 ribs though rare but result in high mortality rate
5th -9th rib common site of fracture

2. Flail Chest,
Multiple rib fractures produce a mobile fragment which moves
paradoxically with respiration

3. Pulmonary Contusion.
Damage to the lung tissues resulting in hemorrhage and localized edema.
Observed in about 20% of adult patients with multiple traumatic injuries
and in higher percentage of children due to increased compliance of the
chest wall.

PENETRATING TRAUMA :

-classified according to their velocity.

1. STAB WOUNDS, are generally considered of low velocity because the weapon
destroys a small areaaround the wound. Knives and switchblades cause most stab
wounds. Appearance of the external wound may be very deceptive, because
 pneumothorax, hemothorax, lung contusion, and cardiac tamponade, along with
severe and continuing hemorrage.

2. GUNSHOT WOUNDS, to the chest may be classified as of low, medium, or

high velocity. The factors determine the velocity and resulting extent of damage
include: the distance from which the gun was fired, the caliber of the gun, and
construction and size of the bullet.

Diagnostic Tests

 Chest X-ray, Chemistry profile, arterial blood gas analysis, pulse oximetry, and
ECG.

 Blood typing and cross matching are done in case blood transfusion is required.

Management
 Immediate management is to restore and maintain cardiopulmonary function.

 after an adequate airway is ensured and ventilation is established, the patient is

examined for shock and intrathoracic and intra-abdominal injuries. The patient is
undressed.

 Death can result from exsanguinating hemorrhage or intra-abdominal sepsis.

 after the peripheral pulse is assessed, large-bore intravenous line is inserted.

 Indwelling Catheter is inserted to monitor urinary output

 Nasogastric tube is inserted to prevent aspiration, minimize leakage of abdominal

contents, and decompress the gastrointestinal tract.

 Shock is treated simultaneously with colloid solutions, crystalloids, or blood, as

indicated by the patient’s condition.

 A chest tube is inserted into the pleural space in most patients with penetrating
wounds of the chest to achieve rapid and continuing re-expansion of the lungs,
results in a complete evacuation of the blood and air.

 Also allows early recognition of continuing intrathoracic bleeding, which would

make surgical exploration necessary.

* If the patient has penetrating wound of the heart and great vessels, the esophagus, or the
tracheobronchial tree, surgical intervention is required.