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 Crimean War (1853-
80 1856)
70
60 American Civil War
Total (1861-1865)
50
Wounded 40 Franco-Prussian
30 War (1870-1871)
20 World War I (1914-
10 1918)
0
World War II (1939-
79% 63% 56% 25% 12%
1945)
% Chest Wound Related Deaths
 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?