9. Condiciones que ponen en riesgo la
vida en forma inmediata
Obstrucción de la vía aérea
Neumotórax a tensión
Neumotórax abierto
Tórax inestable
Hemotórax masivo
Taponamiento cardiaco
Deben detectarse durante la evaluación primaria
17. Tubo endopleural
4to / 5to espacio intercostal entre las líneas
axilar media y anterior
Tamaño 36 en adultos – NO trócares!!!
Nunca por la herida
Sello de agua
22. Hemotórax Masivo
Indicaciones de toracotomía
Drenaje de al menos 1000 ml de sangre
ó
Gasto de al menos 200 ml/h por 2 a 4 horas e
hipotensión sostenida sin otra justificación
No olvide checar signos vitales personalmente
32. Errores y Problemas
Neumotórax simple + intubación
Se convierte en neumotórax a tensión
Hemotórax retenido
Lesión diafragmática inadvertida
Ruptura aórtica inadvertida
Contusión pulmonar con/sin fracturas costales
Extremos de la vida
33.
34. Sumarización
El trauma de tórax es común en el
politraumatizado
Compromete la vida
Usualmente son intervenciones simples
Revalorar siempre después de cada intervención
35. A – Vía Aérea y protección de espina cervical
B – BREATHING Ventilación
C – Circulación y control de hemorragias
D – Discapacidad y secuelas
E – Exposición y prevención de hipotermia
Mismas prioridades en adultos, niños y embarazadas
Concepto A B C
Notas del editor
I have moved up ”Massive haemothorax” (ÅM)
Would be better with a photo or figure of blunt trauma (ÅM)
High mortality due to ABC problems
Don’t be distracted: B problem.
But Flail chest is not immediately life-threatening (ÅM)
An open thorax can be both a pneumo and a haemothorax (ÅM)
What is wrong with this picture? Should not have been taken
Bear in mind that this doesn’t always work in fat or big muscled people; the cannula is too short.
This is a clinical diagnosis! No need for X-ray before putting chest tube!
To collect blood for autotransfusion you can use blood bag
We don’t advocate improvised systems to collect blood-but it is used in some countries.
Never use trocar! We will show film after lecture.
Patient is placed supine with the arm of the injured side flexed and folded behind the head. The skin is cleaned and the side prepped. . The chest wall is anaesthetized from the skin to the parietal pleura, pleura including the neurovascular bundle.
If patient arrived late after injury maybe the bleeding has already stopped and it is old blood you get out. Check patient general condition = vital signs. (ÅM)
Figure added (ÅM)
Never use trocar!
Never use trocar!
Pericardiocentesis not recommended, should be open window or thoracotomy to stop bleeding (ÅM)
New slide (ÅM)
Special note for surgeons
Put chest tube. Dont forget , if you have a stomach injury , the gastric contect can be in contact with the pleura, so before you close the diaphram, wash out the thorax. The last thing you need is pleuritis or secondary empyema. Now you can suture the tear.
Retained haemothorax might develop empyema (ÅM)
Extremes of age: children who can have intrathoracic injuries wihtout rib fractures (ÅM)
It is based on the ATLS course which was created by the American College of Surgeons more than 30 years ago. Since then many other courses have been developed so the concept of ABC can now be said to be common knowledge.
There is AMLS for medical emergencies, one for children, one for burns, one for prehospital care, one for trauma nurses.
