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Chest Thoracic/Skeletal Injury (Clinical Signs & Symptoms (Pain,…
Chest Thoracic/Skeletal Injury
Etiology
Regardless of the specific injury, all trauma management begins with efforts to secure the airway and restore and maintain adequate perfusion, ventilation, and oxygenation using the appropriate basic advance life support protocols.
Penetrating/blunt injury: knife or gunshot wounds.
Blunt injury: Motor vehicle accidents, sports, falls, injuries, crush injuries and explosions.
Clinical Signs
& Symptoms
Pain
Dyspnea
Respiratory distress
Paradoxical chest movement/flail chest
Hypotension/hypertension
Cyanosis
Decreased breath sounds/crackles
Atelectasis
Dysrhythmias/Tachycardia
Lung contusion
Shock
Secondary pneumonia
Pneumothorax
Rib instability
Diagnostic
Tests
Depends on the type
and severity of trauma.
Chest Xray:increased densities,
increased opacities, rib fractures
Bronchoscopy
CT scan
Thoracic ultrasound
12 lead ECG
Cardiac ECHO
Differential
Diagnosis
Rib fractures
Flail chest
Respiratory
Management
Lung Expansion Therapy/Bronchial Hygiene Therapy: prevent pneumonia
Mechanical Ventilation: only to correct ABG NOT TO treat flail chest.
Oxygen Therapy: treat hypoxemia
NIPPV: treat patients with marginal respiratory status
High frequency oscillation ventilation: salvage therapy for patients failing A/C or SIMV with Peep
Independent Lung Ventilation: patient with severe unilateral contusion
Lung protective strategies: ARDS (4-6ml/kg)
Pathophysiology
Flail Chest: Double fractures of at least 3 or more adjacent ribs
Chest trauma may result from either penetrating or blunt injury.
Penetrating trauma: can occur to any thoracic structure.
Spinal Cord
Injuries
Most often seen in MVA, falls, gunshot wounds, and sporting accidents.
CT, MRI, ABG, CBC, airway potency, toxicology, continuous pulse ox and capnometry.
Very similar to thoracic injury
