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Chest Trauma and Pneumothorax

• Within the chest cavity =o Lung, heart, diaphragm, ribs and intercostal muscles

o  The pleura space is the potential space between the parietal and

visceral pleura Visceral- lines the lung

Parietal lines the ribs and intercostal muscles

•  Trauma inuries to the chest can be separated into ! areas"

o #lunt trauma" chest stri$es o% is struc$ by an obect&

'orces = deceleration, acceleration, shearing, and compression

(xternal inury may appear minor but internally inuries can be

severe&o Penetrating trauma" open inury in which a %oreign body impales or

passes through the body tissues& )ni%e wounds, gunshot wounds, and inuries with other sharp

obects& (mergency care is re*uired

o  Thoracic inuries range %rom simple rib %racture to complex li%e

threatening rupture o% organs+

• Pneumothorax" air in the pleural space& s a result o% the air, there is a

partial or complete collapse o% the lung& s volume o% air trapped increases,

the lung volume decreases& This condition should be suspected a%ter any

blunt trauma to the chest& .i/erent Types0 121 o% pneumothorax" dyspnea,

decreased movement o% chest wall, diminished or absent breath sound on

a/ected side, hyperresonance to percussion, increase in respirations, pleuric

pain

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o Closed Pneumothorax" has no associated external wound&

 3ost common is a spontaneous pneumothorax& Caused by

#lebs rupture 4related to smo$ing5 Laceration or puncture inury to the lung 4%ractured ribs5

(xcessive pressure used during manual or mechanical

ventilation (sophageal tear 4%orce%ul vomiting or emergency intubation5

o 6pen Pneumothorax" occurs when air enters the pleural space thru an

opening in the chest wall& 7unshot or stab wound

1urgical thoracotomy

Penetrating chest wound

• 1uc$ing chest wound- air will enter the pleural thru the

chest wall during inspiration&o (mergency treatment, cover with and occlusive

dressing, and tape on 8 sides to prevent air %rom

entering the pleural space via the woundo  9' T:( 6#;(CT that caused the open wound is still

in place, do not remove it until the physician is

present& 9nstead stabili<e it with a bul$y dressing&o  Tension pneumothorax" rapid accumulation o% air 2

increasing pleural pressure resulting %rom either

open or closed pneumothorax&

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esults in compression o% the lung on

a/ected side 2 pressure on heart and

vessels pushes them away %rom a/ected

side& 4mediastinal shi%t5 3edical emergency" needle decompression

%ollowed by chest tube insertion with waterseal drainage system

•  The emergency management is to

insert a Large-bore needle into the

anterior chest wall at the >th or ?th

intercostal space to release the

trapped air& 121 o% tension pneumothorax" cyanosis, air

hunger, violent agitation, tracheal deviation

away %rom a/ected side, 1@ emphysema,

nec$ vein distension, decreased or absent

breath sound on the a/ected side, and

hyperresonance to percussion& Patient is

likely to die from inadequate cardiac

output or severe hypoxemia if not

relieved. Can result %rom clamped or bloc$ed chest

tubes, unclamping or relie% o% obstruction will

remedy this situation&o :emothorax" accumulation o% blood in the pleural space %rom an

intercostal blood vessel, the internal mammary artery, the lung, the

heart, or the great vessels& When it occurs wA pneumothorax = hemopneumothorax

#lood %rom a closed :emothorax can be recovered and rein%used

%or a short period o% time a%ter the inury&o Chylothorax" presence o% lymphatic Buid in the pleural space& The

thoracic duct is disrupted either traumatically or %rom a malignancy 2

lymphatic Buid lls the pleural space& 3il$y white Buid, high in lipids

?DE will heal with conservative treatment 4bowel rest, chest

drainage, 2 parenteral nutrition5 6ctreotide can reduce the Bow o% lymphatic Buid

dditional options " 1urgery and pleurodesis 4articial productiono% adhesionsF usually done with a chemical sclerosing agent, li$e

talc or doxycycline5o C6LL#6T9V( C(G treatment depends on severity and nature o%

underlying disease 9% patient is stable 2 amt& o% air andAor Buid accumulated in the

intrapleural space is minimal0&no treatment may be needed

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9% the amt& o% airABuid is minimal, the pleural space may be

aspirated with a large-bore needle 4thoracentesis5

o

o  The most common treatment is to insert a chest tube 2 connect it to

water-seal drainage& 'or ir- !nd intercostal spaceF %or Buid Hth 

intercostal space&

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5 1uction control chamber #5water seal chamber C5 Water seal

chamber.5 Collection chamber