Lecture on Chapter 30: Chest Injuries

Overview

• Understand management of patients with chest trauma.
• Recognize life threats and provide immediate intervention.
• Covers anatomy, physiology, pathophysiology, complications, assessment, and management of chest injuries.
• Discusses pediatric and geriatric trauma specifics.
• Information on morbidity, mortality, and types of trauma (blunt vs. penetrating).
• Specific injuries: sucking chest wounds, pneumothorax, tension pneumothorax, hemothorax, flailed chest, pericardial tamponade.

Chest Trauma Facts

• Causes over 1.2 million emergency visits annually.
• Can involve heart, lungs, great vessels.
• Caused by blunt or penetrating trauma.
• Immediate treatment needed for injuries affecting breathing.

Anatomy and Physiology

• Thoracic Cage: Extends from neck to diaphragm.
• Ventilation vs. Oxygenation:
  • Ventilation is air movement in/out of lungs.
  • Oxygenation is delivering oxygen into blood.
• Components:
  • Intercostal Muscles: Between ribs, not fully developed in children.
  • Pleura: Covers lungs (visceral) and chest wall (parietal).
  • Mediastinum: Contains heart, great vessels, esophagus, trachea.
  • Diaphragm: Separates thoracic and abdominal cavities.

Mechanics of Ventilation

• Inhalation: Intercostal muscles and diaphragm contract, decreasing pressure, allowing air in.
• Exhalation: Muscles relax, pushing air out.
• Tidal Volume: Air per breath (~500 mL).
• Minute Volume: Tidal volume x breaths per minute.

Types of Chest Injuries

• Closed Injuries: No skin break, often from blunt trauma.
• Open Injuries: Object penetrates chest wall.
• Blunt Trauma: Can fracture ribs, injury heart/lungs, cause aortic damage.

Injury Signs and Symptoms

• Pain at injury site, increased with breathing.
• Bruising, crepitus, penetrating injuries.
• Unequal chest wall expansion, rapid pulse, low BP.

Patient Assessment

• Scene Size-Up: Ensure safety, determine mechanism of injury, consider spinal stabilization.
• Primary Assessment: Address life-threatening issues, check airway, breathing, circulation.
• Transport Decision: Rapid transport for airway, breathing, circulation issues.
• History Taking: Focus on mechanism of injury, obtain SAMPLE history.
• Secondary Assessment: Physical exam, vital signs, reassess regularly.

Management of Specific Injuries

• Pneumothorax: Air in pleural space; treat with occlusive dressing.
• Tension Pneumothorax: Progressive air buildup; urgent decompression needed.
• Hemothorax: Blood in pleural space; requires surgical intervention.
• Cardiac Tamponade: Blood/fluid in pericardial sac; rapid transport.
• Rib Fractures: Often in older patients; provide oxygen.
• Flail Chest: Paradoxical motion; support ventilation.
• Traumatic Asphyxia: Compression injuries causing cyanosis, hemorrhage.
• Commotio Cordis: Sudden cardiac arrest from chest impact.

Review Questions

1. Aortic shearing is a leading cause of death post-trauma.
2. Vomiting blood is not a common sign of chest injury.
3. Cover stab wounds with an occlusive dressing immediately.
4. Ventilatory inadequacy is a concern with pneumothorax.
5. Flutter valves allow trapped air release, prevent air re-entry.
6. Cardiac tamponade signs exclude collapsed jugular veins.
7. Traumatic asphyxia signs include facial cyanosis.
8. Commotio Cordis involves cardiac arrest after chest impact.
9. Paradoxical motion indicates a flail chest.

Conclusion

• Comprehensive understanding of chest injuries is crucial for effective management and treatment.
• Importance of rapid assessment, intervention, and transport in trauma scenarios.

End of Chapter 30 Lecture on Chest Injuries.