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PTC
1
BREATHING
(VENTILATION)
PTC
2
ASSESSMENT
 Inspection (LOOK)
 Palpation (FEEL)
 Auscultation (LISTEN)
 Resuscitate
PTC
3
INSPECTION
Respiratory rate
Accessory muscle use
Cyanosis
Penetrating injury
Flail chest
Sucking chest wound
PTC
4
PALPATION
Tracheal shift
Rib fractures
Subcutaneous emphysema
Percussion
PTC
5
AUSCULTATION
Breath sounds
Heart sounds
Bowel sounds
PTC
6
TENSION PNEUMOTHORAX
Respiratory distress
Tachycardia
Hypotension
Distended neck veins
Resonant percussion note
Tracheal deviation
 Air entry
PTC
7
TENSION PNEUMOTHORAX
MANAGEMENT
 Immediate decompression
 Large bore needle
 Second intercostal space
 Mid clavicular line
 Formal chest drain to follow
PTC
8
TENSION PNEUMOTHORAX
Should be a clinical diagnosis
Treat before X-ray
PTC
9
CHEST TRAUMA
PTC
10
CHEST TRAUMA
 Cause of ~25% of trauma deaths
 Immediate deaths due to major disruption of
heart and great vessels
 Early deaths due to airway obstruction,
cardiac tamponade or aspiration
PTC
11
CHEST TRAUMA
RESPIRATORY DISTRESS
 Rib fractures/flail chest
 Pneumothorax (simple, tension, open)
 Haemothorax
 Pulmonary contusion
 Aspiration
PTC
12
CHEST TRAUMA
HAEMORRHAGIC SHOCK
Haemothorax
Haemomediastinum
BEWARE HIDDEN HAEMORRHAGE
PTC
13
CHEST TRAUMA
RIB FRACTURES
 May occur at point of impact
 Often associated with pulmonary
contusion
 May result from simple trauma in the
elderly
 Remember analgesia
PTC
14
CHEST TRAUMA
FLAIL CHEST
 Ventilation  due to pain, contusion and
compromised respiratory mechanics
 Adequate analgesia is vital
 Give oxygen (if available)
 Consider intubation and IPPV
PTC
15
CHEST TRAUMA
TENSION PNEUMOTHORAX
 Air enters the pleural space but cannot leave
 Intrathoracic pressure resulting in mediastinal
shift,  VR and  CO
 Respiratory distress and hypoxia follow
PTC
16
CHEST TRAUMA
TENSION PNEUMOTHORAX
LIFE THREATENING EMERGENCY
CLINICAL DIAGNOSIS
URGENT DECOMPRESSION
ESSENTIAL
PTC
17
TENSION PNEUMOTHORAX
 respiratory distress
 tachycardia
 hypotension
 distended neck veins
 resonant percussion note
 tracheal deviation
  air entry
PTC
18
TENSION PNEUMOTHORAX
MANAGEMENT
 Immediate decompression
 Large bore needle
 Second intercostal space
 Mid clavicular line
 Formal chest drain to follow
PTC
19
CHEST TRAUMA
SIMPLE PNEUMOTHORAX
Any pneumothorax must be treated prior to
PPV to prevent occurrence of a tension
pneumothorax.
PTC
20
CHEST TRAUMA HAEMOTHORAX
 More common in penetrating than in blunt
trauma
 Hypovolaemic shock may occur
 Large bore chest tube will drain blood and
tamponade any bleeding chest wall vessels
 Consider thoracotomy if bleeding continues >
200-300 ml/hr
PTC
21
CHEST TRAUMA
PULMONARY CONTUSION
 Potentially life threatening
 Occurs with blunt and penetrating
trauma
 Suspect if rib fractures
 Onset often slow and progressive over 24
hours
PTC
22
CHEST TRAUMA
OPEN PNEUMOTHORAX
 “Sucking” chest wound
 Other signs of pneumothorax present
 Occlude wound (on 3 sides only) to permit
air to escape on expiration
 Urgent insertion of chest drain
PTC
23
CHEST TRAUMA
MYOCARDIAL CONTUSION
 Contusion is common in blunt trauma
 Contusion can mimic myocardial infarction
 Can cause sudden death after the accident
 ECG monitoring (if available)
PTC
24
CHEST TRAUMA
OTHER INJURIES
Pericardial tamponade
Great vessel injury
Airway rupture
Oesophageal trauma
Diaphragmatic injury
PTC
PERICARDIAL TAMPONADE
 Clinically apparent cardiac tamponade may
result from 60-100 ml of blood:
 BECK’S TAMPONADE TRIAD:
- Hypotension
- JVD
_ Muffled heart sounds
 Mx: Needle pericardiocentesis (decompression)
25
PTC
26
TRAUMA IN PREGNANCY
PTC
27
THE PREGNANT PATIENT
 Important anatomical and physiological
considerations
 Resuscitation of the mother is also
resuscitation of the foetus
 Mother comes first
TRAUMA MANAGEMENT
PRINCIPLES ARE THE SAME
PTC
28
ANATOMICAL CHANGES
FUNDAL HEIGHT
12 weeks symphysis pubis
20 weeks umbilicus
36 weeks xiphoid
PTC
29
PHYSIOLOGICAL CHANGES
  tidal volume and respiratory alkalosis
 Cardiac output  30%
 Blood volume  40%
 BP  15mmHg in second trimester
 HR  10-15
 Prone to aortocaval compression
PTC
30
SPECIAL ISSUES
 Uterine irritability and premature
labour
 Rupture of uterus (partial or complete)
 Placental separation
 Pelvic fractures may result in severe
blood loss
PTC
31
MANAGEMENT PRIORITIES
 ABCDE of mother
 Left lateral tilt
 Vaginal examination
 Mark fundal height
 Look for fundal tenderness
 Monitor foetal heart rate

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Chest injuries.ppt

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