1 / 63

Chapter 23

Chapter 23. Chest and Abdominal Trauma. Overview. Anatomy Review Chest Trauma Chest Injuries Abdominal Trauma Abdominal Injuries. Anatomy Review. Thoracic cavity and abdominal cavity: two spaces in the trunk of the body They contain some of the body’s most important organs. Chest Trauma.

aislin
Download Presentation

Chapter 23

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 23 Chest and Abdominal Trauma

  2. Overview • Anatomy Review • Chest Trauma • Chest Injuries • Abdominal Trauma • Abdominal Injuries

  3. Anatomy Review • Thoracic cavity and abdominal cavity: two spaces in the trunk of the body • They contain some of the body’s most important organs

  4. Chest Trauma • Chest injuries result in a significant number of deaths each year • The chest contains organs vital to life • Damage to vital organs threatens life • Most common consequence is hypoxia

  5. Chest Trauma • Mechanism of injury (MOI): Blunt chest trauma • Most common cause of serious chest injuries • Motor vehicle collisions (MVCs), falls, direct blows, and crushing injuries • Many injuries are not immediately apparent in physical exam

  6. Chest Trauma • Mechanism of injury (MOI): Blunt chest trauma • Injuries linked to size of object applying force and most important, to speed • Speed kills

  7. Chest Trauma • MOI: Blunt chest trauma • Evaluating MOI at a motor vehicle collision • Significant damage to vehicle’s exterior? • Damage to interior of vehicle? • Broken or bent steering wheel means significant force was applied to the driver’s chest • The higher the forces, the higher the suspicion for serious injury to patient

  8. Chest Trauma • MOI: Penetrating trauma • Increasingly common in today’s society • Immediate result can be severe bleeding or impaired breathing

  9. Chest Trauma • MOI: Penetrating trauma • Any chest wound can involve underlying organ injury • No matter how superficial it looks • Injuries to the heart, lungs, and great vessels can quickly lead to shock and cardiac arrest

  10. Chest Trauma • Signs and symptoms • Most common symptoms: pain and difficulty breathing • Signs are obvious injury to the chest wall • Use DCAP-BTLS, looking at both the front and back of the chest • Note any subcutaneous emphysema, or air present under the skin

  11. Chest Trauma • Assessment • Follow all steps in the assessment of the trauma patient

  12. Chest Trauma • Management • Ensure patient has adequate oxygenation and perfusion • Provide high-flow oxygen, ventilating when necessary • Halt any obvious bleeding

  13. Chest Trauma • Management • Support circulation when needed • Rapidly transport patient to definitive care

  14. Chest Trauma • Transport • Transport patient to a hospital with the capability to diagnose and treat serious traumatic injuries • Arrange for ALS intercept as guided by local protocols • Notify receiving hospital so staff can prepare

  15. Chest Injuries • Open chest wounds • A sharp object penetrates the skin on the chest wall • Laceration of vessels such as the vena cava or aorta will likely cause bleeding between the lung and the chest wall • The accumulation of blood in the pleural space is called a hemothorax

  16. Chest Injuries • Open chest wounds • If penetrating object has pierced pleura, outside air can enter the thoracic cavity • As the volume of air in the thoracic cavity expands, the lung starts to collapse • Air within the pleural space is called a pneumothorax

  17. Chest Injuries • When air enters between the lung and the chest wall, pneumothorax is created

  18. Chest Injuries • Open chest wounds • As air passes in and out of an open wound, it can create a sucking-type sound • Sucking chest wound means possibility of pneumothorax • Signs of pneumothorax: difficulty breathing, cyanosis, diminished breath sounds on the affected side

  19. Chest Injuries • Open chest wounds: Management • Cover open chest wounds with occlusive dressing • Gloved hand is an effective temporary occlusive dressing • Secure dressing on three sides

  20. Chest Injuries • Open chest wounds: Management • High-flow oxygen • Transport with unaffected side slightly elevated • Arrange for ALS intercept

  21. Open Chest Wound • Watch this animation illustrating management of an open chest wound.

  22. Stop and Review • Name three signs of a simple pneumothorax.

  23. Chest Injuries • Tension pneumothorax • Buildup of pressure in pleural space resulting in decrease in blood pressure • Potentially life-threatening condition that must be treated immediately • Can occur in blunt or penetrating chest trauma

  24. Chest Injuries • Increasing pressure in the lung pushes the heart and the great vessels to the opposite side of the chest.

  25. Chest Injuries • Tension pneumothorax: Signs • Include all those of a pneumothorax • Jugular venous distension (JVD) • If ventilating becomes more difficult, significant lung compression is indicated

  26. Chest Injuries • Tension pneumothorax: Signs • Tracheal deviation is a late sign • If patient is hypotensive, immediately lift a corner of the occlusive dressing • Transport this patient rapidly • Consider ALS intercept

  27. Chest Injuries • Rib fractures • Local swelling and tenderness may be the only sign of a broken rib • Can be very painful • Patients often present with guarding and shallow breathing

  28. Chest Injuries • Rib fractures: Management • Move the patient carefully to prevent the bone ends from puncturing a lung • Administer oxygen

  29. Chest Injuries • Rib fractures: Management • Allow patient to self-splint by assuming the most comfortable position possible • Encourage patient to limit movement

  30. Chest Injuries • Flail segment • When three or more ribs are broken in two or more places, a rib-cage segment may detach from the rest • Flail segment is free floating

  31. Chest Injuries • Flail segment • Paradoxical movement: movement of flail segment in opposite direction of the rest of the chest wall • Paradoxical movement can significantly impair breathing and cause injury to the underlying lung

  32. Flail Chest Segment • Watch this animation of a flail chest segment.

  33. Chest Injuries • Flail segment: Management • Quickly stabilize flail segment by placing gloved hand over injured area • After manual stabilization, place folded universal dressing over segment and tape securely

  34. Chest Injuries • Flail segment: Management • Consider assisting patient’s breathing if tachypnea increases • Transport on side with unaffected lung on top

  35. Chest Injuries • Pulmonary contusion • Bleeding into the lung itself is a pulmonary contusion • Bleeding and edema can impair gas exchange, causing hypoxia • Soft crackles may be heard over injury site • Chest pain, point tenderness, and localized swelling over area of impact

  36. Chest Injuries • Pulmonary contusion: Management • Support ventilation as needed • Supply high-flow supplemental oxygen • Transport to hospital

  37. Chest Injuries • Cardiac contusion • Can impair heart’s ability to pump • Bleeding into heart tissue can cause heart to beat irregularly • Irregular pulse should alert EMT to possibility of a cardiac contusion

  38. Chest Injuries • Cardiac contusion: Management • High-flow oxygen • Ventilation support as needed • Support of circulation if appropriate • Prompt transport • Request ALS backup

  39. Chest Injuries • Pericardial tamponade • Bleeding around heart and into pericardial sac that encloses the heart can cause pericardial tamponade • Usually results from a penetrating chest trauma with laceration to the heart itself

  40. Chest Injuries • Pericardial tamponade • Blood filling the pericardial sac compresses heart, causing blood to back up • JVD is a telltale sign of pericardial tamponade • Narrowed pulse pressures

  41. Chest Injuries • Pericardial tamponade: Management • High-flow oxygen • Treat patient for shock • Transport rapidly to ED • Request ALS intercept • Notify hospital so staff can properly prepare

  42. Chest Injuries • Aortic injury • In sudden decelerations such as high-speed head-on MVCs, body organs are thrown forcefully against the front of the body • Most significant tear: aorta • If tear is complete, patient will die in minutes • Incomplete tears bleed severely

  43. Chest Injuries • Aortic injury: Management • High-flow oxygen • Treat patient for shock • Transport rapidly to ED • Notify hospital so staff can properly prepare

  44. Chest Injuries • Traumatic asphyxia • Rapid ejection of blood and air out of chest • Rapid compression of chest increases internal pressure dramatically • Blood is immediately forced out of the chest and into the vessels in the neck, head, and face

  45. Chest Injuries • Traumatic asphyxia • Neck veins immediately become distended • Cyanosis is apparent in face • Bleeding in the eyes’ sclera may occur

  46. Chest Injuries • Traumatic asphyxia: Management • High-flow oxygen • Treat patient for shock • Transport rapidly to ED • Notify hospital so staff can properly prepare

  47. Abdominal Trauma • MOI: Penetrating abdominal trauma • Stab or gunshot wound to abdomen, no matter how superficial, can seriously injure internal organs

  48. Abdominal Trauma • MOI: Penetrating abdominal trauma • Inquire • Kind of knife and length? • Caliber of gun? • How many shots were fired? • Trajectory?

  49. Abdominal Trauma • MOI: Blunt abdominal trauma • External signs of injury may not be readily apparent • Injury potential is as great as that of a penetrating trauma • Most vehicle air bags don’t protect against abdominal injury from lateral impacts in an MVC • Improper use of seat belts may cause abdominal injury in a collision

More Related