Chest injury

General Surgery

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Chest injury

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Thoracic injury :
Trauma is the leading cause of death , hospitalization, short & long standing disability at any age, any sex, 25% of all traumatic death are due to chest injury , Second leading cause of trauma deaths after head injury, in war time chest injury are more common than civil & almost always there is a possibility of multiple injury.
Introduction

• Mosul university- College of dentistry-oral & maxillofacial surgery department

• Chest injuries may result from:
• Vehicle accidents RTA
• Falls
• Gunshot wounds
• Crush injuries
• Stab wounds
Introduction


• Mosul university- College of dentistry-oral & maxillofacial surgery department

Anatomy of the Thorax

Trachea

Lungs
Bronchi
Mediastinum
Heart
Pleura
Ribs
Intercostal muscles
Diaphragm

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Penetrating trauma
Gunshot
Stab wounds


Blunt trauma
Mechanism of injury
• Mosul university- College of dentistry-oral & maxillofacial surgery department

Assess the casualty

Identify signs and symptoms
Airway
Breathing
Circulation

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Signs & symptoms of chest injury
Shock
Cyanosis
Hemoptysis
Chest wall contusion
Open wounds
Distended neck veins
Tracheal deviation
Subcutaneous emphysema


• Mosul university- College of dentistry-oral & maxillofacial surgery department

Chest injuries

Chest wall injuries

Lung injury

Heart , aorta and diaphragm injuries

Chest wall injuries

Rib fractures
Flail chest
pneumothorax
haemothorax
• Mosul university- College of dentistry-oral & maxillofacial surgery department

Rib fractures

Most common thoracic injury
Most commonly 5th to 9th ribs
Poor protection
Localised pain, tenderness, crepitus
CXR to exclude other injuries
Analgesia..avoid taping
Upper ribs, clavicle or scapula fracture: suspect vascular injury
Fractures of 8th to 12th ribs can damage underlying abdominal solid organs:
Liver
Spleen
Kidneys


• Mosul university- College of dentistry-oral & maxillofacial surgery department

Flail chest

Two or more adjacent ribs are fractured in at least two places or separation of sternum from ribs
Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration
Significant force required
Usually diagnosed clinically
Rx: ABC Analgesia

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Flail Chest

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Pneumothorax

Air in the pleural cavity
Blunt or penetrating injury that disrupts the parietal or visceral pleura
Unilateral signs: movement and breath sounds, resonant to percussion
Confirmed by CXR
Rx: chest drain
• Mosul university- College of dentistry-oral & maxillofacial surgery department


• Mosul university- College of dentistry-oral & maxillofacial surgery department

Pneumothorax

Pneumothorax (closed)

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Pneumothorax

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Tension pneumothorax

Air enters pleural space and cannot escape
P/C: chest pain, dyspnoea
Dx: - respiratory distress
- tracheal deviation (away)
- absence of breath sounds
- distended neck veins
- hypotension


• Mosul university- College of dentistry-oral & maxillofacial surgery department

Surgical emergency

Rx: emergency decompression before CXR
Either large bore cannula in 2nd ICS, MCL or insert chest tube
CXR to confirm site of insertion
• Mosul university- College of dentistry-oral & maxillofacial surgery department
Tension pneumothorax

Open pneumothorax

Defect in chest wall provides a direct communication between the pleural space and the environment
Lung collapse and paroxysmal shifting of mediastinum with each respiratory effort ± tension pneumothorax
“Sucking chest wound”
Rx: ABCs…closure of wound…chest drain
• Mosul university- College of dentistry-oral & maxillofacial surgery department

Open Pneumothorax

• Mosul university- College of dentistry-oral & maxillofacial surgery department

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Open Pneumothorax

Haemothorax

Blunt or penetrating trauma
Requires rapid decompression and fluid resuscitation
May require surgical intervention
Clinically: hypovolaemia, absence of breath sounds, dullness to percussion.
CXR may be confused with collapse
• Mosul university- College of dentistry-oral & maxillofacial surgery department

Loss of 1500 cc blood or 200 cc per hour from the chest tube

Signs and symptoms
Hypotension from blood loss or compression of great vessels
Dullness to percussion
Decreased breath sounds
Anxiety or confusion secondary to hypovolemia or hypoxia
Massive Hemothorax



• Mosul university- College of dentistry-oral & maxillofacial surgery department

Lung injury

Pulmonary contusion
Pneumothorax
Haemothorax
Parenchymal injury
Trachea and bronchial injuries
Pneumomediastinum
• Mosul university- College of dentistry-oral & maxillofacial surgery department

Heart, Aorta & Diaphragm

Blunt cardiac injury
-contusion
-ventricular, septal or valvular
rupture
Cardiac tamponade
Ruptured thoracic aorta
Diaphragmatic rupture
• Mosul university- College of dentistry-oral & maxillofacial surgery department


Iatrogenic trauma
NG tubes:
-coiling
-endobronchial placement
-pneumothorax
Chest tubes:
- subcutaneous
- intraparenchymal
- intrafissural
Central lines:
- neck
- coronary sinus
- pneumothorax
• Mosul university- College of dentistry-oral & maxillofacial surgery department

Line in jugular vein

• Mosul university- College of dentistry-oral & maxillofacial surgery department

Misplaced nasogastric tube

• Mosul university- College of dentistry-oral & maxillofacial surgery department