Chest injuries are common and can be life-threatening. The document discusses various types of chest injuries including blunt trauma, penetrating trauma, and compression injuries. It covers anatomy of the chest, definitions, causes, symptoms, management, and potential complications of specific injuries like pneumothorax, hemothorax, flail chest, and cardiac tamponade. Immediate life-threatening injuries require stabilization of the airway, breathing, and circulation before further treatment.

1. Mrs.JEEVA.D
NURSING TUTOR,
GANGA COLLEGE OF NURSING,
COIMBATORE.

3.  INTRODUCTION
 ANATOMY
 DEFITION
 TYPES
 CAUSES
 SYMPTOMS
 MANAGEMENT
 COMPLICATION

4.  Second leading cause of trauma deaths
 Around 65 -70% of chest injuries are due to RTAs
 Approx. 25% of deaths are due to chest injuries
 50 % of patients who die from poly trauma have
significant chest injuries.

7.  Thoracic Inlet..
 Connects thoracic cavity to the root of the Neck.
• Thoracic Outlet…
 Connects thoracic cavity with the Abdomen.
Closed by Diaphragm.
 Thoracic Wall
 Posteriorly… Thoracic vertebrae 12.
 Anteriorly… Sternum and Costal Cartilages.
 Laterally… Ribs and Intercostal spaces.

8. • Trachea
• Bronchi
• Lungs
• Heart
• Great
Vessels.
• Oesophagus

9.  CHEST TRAUMA / INJURY : It is any form of
physical injury to the chest including ribs, heart and
lungs.
 Thoracic injury… 25% of all injuries.
 In another 25%, its contributor to other injuries.
 Major Cause of death…. Hemorrhage.

10. • Blunt Trauma-
 Blunt force to chest.
• Penetrating Trauma-
 Projectile that enters chest causing small or large
hole.
• Compression Injury-
 Chest is caught between two objects and chest is
compressed.

11.  BLUNT – This type of injury is caused by coming into
contact with some solid object that causes increased
intra thoracic or chest cavity pressure.
 Penetrating – A penetrating injury is one that involves
piercing of the chest cavity by foreign object.

12.  Blast – These types of injuries are associated with
explosions.
 Inhalation – An inhalation chest injury is one caused by
gases, fumes, dusts, or even liquids entering the lungs.

13. IMMEDIATE
• Within seconds to minutes
• Disruption of heart or great vessels injury
EARLY
• Within few minutes to hours
• Airway obstruction, tension pneumothorax,
pulmonary contusion or cardiac tamponade
LATE
• Within few days to weeks
• Pulmonary complications, sepsis and missed
injuries

14. Immediately Life
threatening
• Airway obstruction
• Simple / Closed
Pneumothorax
• Open Pnuemothorax
• Tension Pneumothorax
• Massive Hemothorax
• Flail Chest
• Cardiac Tamponade
Potentially life
Threatening
• Cardiac Contusion
• Aortic Disruption
• Diaphragmatic rupture
• Esophageal Injury
• Pulmonary Contusion
• Tracheo bronchial
injury

15.  Low velocity penetration
 Knife (stab wound)
 Airway Obstruction
 Caustic Injury
(Poisoning)
 Burns
 Electrocution
Acceleration / deceleration
(RTA)
Body compression
(crush injury)
High speed impact
(gunshot wound)
Miscellaneous

16. Chest Injury
Intra Plural Space Increases
Lung Collapse
Mediastinum Shift

17. Compression of Large Veins
Carbon Oxide Decreases
Cardiac Arrythmias
Sudden Death

19.  SIMPLE / CLOSED
PNEUMOTHORAX - Defined as
accumulation of air within the pleural
space producing a collapsed lung.
 Air leak is secondary to a fractured rib
penetrating the lung or stab wound
through the parietal & visceral pleura.
 Symptoms – chest pain, shortness of
breath, coughing, rapid breathing, an
abnormal breathing movemnt
 On percussion : Hyper resonance on the
affected side
 On Auscultation : Decreased breath
sounds on affected side.

20.  ABC’s with C-spine control
 Chest tube placement
 Airway Assistance as needed
 Provide supportive care
 Usually small and self limiting.
 Monitor for Development of Tension Pneumothorax

22.  Open Pneumothorax
-it occurs when air accumualtes between the chest wall
and the lung as the result of an open chest wound or other
physical defect. The larger opening, the greater degree of
lung collapse and difficulty of breathing.
 On exam : Obvious chest wall defect
 On auscultation : Complete or near complete loss
of breath sounds
 Diagnosis : Physical exam and CXR

23.  Dyspnea
 Sudden sharp pain
 Subcutaneous Emphysema
 Decreased breath sounds on affected side
 Hyper-resonance
 Red Bubbles on Exhalation from wound (a.k.a. Sucking
chest wound)
 DIAGNOSTIC EVALUATION
 CHEST X-RAY Standing.
 Smaller pneumothorax may need Expiration CXR or CT

24.  Sucking chest wound : Placing a three way occlusive
dressing.
 Intent is to prevent the rise of intrathoracic pressures in
the affected hemothorax
 A chest tube is then placed. Afterinitial stabilization,
definitive chest wall closure is planned
 Observation…. Small pneumothorax, Asymtomatic.
 Aspiration.
 Chest Intubation…Gold standard,
 Pleurectomy
 Pleurodesis…. Sclerosig agents… Doxy, Bleomycin, talc.
 Surgery…needed in less than 20%...Thoracotomy.

26.  Develops when a lung or chest wall injury is such
that it allows air into the pleural space but not out of it
( a one way valve)
 As a result, air accumulates & compresses the lung,
resulting into :
 - Shifting of mediastinum
 -Compression of contralateral lung
 Symptoms :Sharp & stabbing chest pain, dyspnea,
cyanosis, sweating ,fainting

27.  Symptoms - Distended neck veins
 Hypotension or evidence of hypo perfusion,
 Diminished or absent breath sounds on affected side,
 Tracheal deviation to the contralateral side
 Diagnosis : Clinically before the CXR is obtained.
 Immediate needle decompression of the chest with a
16G in 2nd intercostal space, midclavicular space.
 Once accomplished, a chest tube is placed.

28.  Hemothorax following a blunt/
penetrating wound to the chest can be
caused by bleeding from any structure in
the thorax : the intercostal arteries,lung,
great vessels or heart.
 On percussion : Diminished breath
sounds & dullness to percussion over
affected hemi thorax
 Massive hemothorax can produce
significant hemodynamic instability
secondary to hemorrhagic shock.

29.  Anxiety/Restlessness
 Tachypnea
 Signs of Shock
 Frothy, Bloody Sputum
 Diminished Breath Sounds on Affected Side
 Dull percussion note… maybe resonant in supine
position.
 Tachycardia
 Flat Neck Veins

30.  ABC’s with c-spine control as indicated
 General Shock Care due to Blood loss
 Chest intubation
 Thoracotomy… If more than 1500 ml blood drains
initially, or ongoing hemorrhage of more than 200 ml/
hr over 3-4 hrs.

31. A flail chest occurs when a segment of the rib cage
breaks under extreme stress and becomes detached
from the rest of the chest wall.
This is usually defined as at least two fractures per rib
(producing a free segment), in at least two ribs.
some definitions require three or more ribs in two or
more places

32.  Respiratory distress – mc initial presentation
 Dyspnea, tachycardia, tachypnea, pain & tenderness
usually present.
 On auscultation : Decreased breath sounds over the
affected area.
 DIAGNOSIS : Physical examination & CXR CT:
identification of early pulmonary contusion

33.  Treatment modalities for patients with chest wall
fractures are appropriate for flail chest
 Pain control, pulmonary toilet, Oxygen : Primary
therapy for pulmonary contusion
 Severity of flail injuries & associated contusions
may require endotracheal intubation & IPPV
 Optimal ventilatory management is crucial

34.  Use Trauma bandage and
Triangular Bandages to splint
ribs.
 Can also place a bag of D5W
on area and tape down. (The
only good use of D5W I can
find)

35.  Life threatening
complication caused by
excessive accumulation of
fluid in the pericardium
leading to :
 Compression of cardiac
chamber
 Impaired cardiac filling
 Reduction in stroke volume

36.  Distended Neck Veins
 Increased Heart Rate
 Muffled heart sound
 Respiratory Rate increases
 Poor skin color
 Hypotension
 Death
 Beck’s Triad… Low BP, Raise venous pressure,
Muffled Heart sounds.

37.  CHEST X-RAY enlarged Globular heart shadow.
 Echo…. Fluid in pericardial sac.
 Central venous pressure… high
 CT scan
 TREATMENT
 ABC’s with c-spine control as indicated
 High Flow oxygen.
 Treat S/S of shock
• Rapid Transport
 What patient needs is Pericardiocentesis

39.  It is a bruise of the heart muscle, which can occur with
serious bodily injury, caused by
 Road tracffic accident
 Falling from height
 Chest compressions
 Symptoms – pain above the ribs, tachycardia, fatigue,
shortness of breath, light headedness, nausea vomiting
and weakness.

40.  Chest X-Ray
 CT scan of chest
 Echocardiogram & CBC
 TREATMENT
 Chest tube placement
 Placement of pacemaker
 Surgical repair of blood vessels.

42.  It is acondition in which the aorta is torn or ruptured as
aresult of trauma to the body.
 Most common cause of sudden death after MVA or fall
from height
 Relatively fixed distal to the origin of Left subclavian
artery.
 The heart, more or less, just hangs from the aortic arch
much like a big pendulum.
 Deceleration Injury
 If Intima and media are disrupted, but Adventitia is
intact……. Pt may be Stable.

43.  Burning or Tearing Sensation in chest
or shoulder blades
 Rapidly dropping Blood Pressure
 Pulse Rapidly Increasing
 Asymmetry of both upper limbs, or upper
and lower limbs Blood Pressure.
 Widened Pulse Pressure.
 Chest wall contusions
 Rapid Loss of Consciousness.

44.  CHEST X-RAY Erect…. Widened Mediastinum
 Aortogram.
 CT with Contrast.
 Trans-esophageal echo.
TREATMENT
 ABC’s with c-spine control as indicated
 High Flow oxygen.
 Treatment for Shock
 Control of systolic B.P to less than 100mmHg.
 Stenting.
 Direct repair
 Excision and grafting using a Dacron graft.

46.  A tear of the diaphragm, the muscle across the
bottom of the ribcage that palys a crucial role
in inspiration. Most commonly acquired by
physical trauma.
 A tear in the Diaphragm that allows the
abdominal organs enter the chest cavity.
 Any penetrating injury to or below 5th
intercostal space can cause diaphragmatic
penetration & abdominal injury.
 usually large, with herniation of the
abdominal contents into the chest.

47.  Abdominal Pain
 Shortness of Air
 Decreased Breath Sounds on side of rupture
 Bowel Sounds heard in chest cavity
DIAGNOSTIC EVALUATION
 - Chest radiography after placement of a nasogastric tube,
Contrast studies of the upper or lower gastrointestinal tract,
CT scan & diagnostic peritoneal lavage.
 Most accurate evaluation is by video-assisted
thoracoscopy (VATS) or laparoscopy.

48.  .Operative Repair.
 Penetrating diaphragmatic injury must be repaired via
the abdomen and not the chest, to rule out penetrating
hollow viscus injury.
 Laproscopy can be done.

50.  Results from penetrating trauma; blunt injury is rare
 Patient can present with odynophagia, subcutaneous
or mediastinal emphysema, pleural effusion, air in the
retro-oesophageal space and unexplained fever within
24 hours of injury
 Combination of oesophagogram and
oesophagoscopy confirm diagnosis
 CT can be done
 Treatment is operative repair and drainage
 Mid-oesophageal injury => Right thoracotomy.
 Distal oesophageal injury => Left thoracotomy.

51. Entry into cervical or
mediastinal fascial planes
of:
Air Gastric
juice
Bacteria and
Saliva
Sepsis Pneumo
nia
CV Collapse

53.  Crushing and bruising of the lung parenchyma.
 Sudden blow or blunt injury to the chest =>
compression of thoracic cavity and lung followed by
an equally sudden decompression. Concussive and
compressive force is most important cause.
 The natural progression of pulmonary contusion
is worsening hypoxemia for the first 24 to 48
hours.
 X-ray findings not significant initially.
 CT with contrast is confirmatory.

54.  Hemoptysis
 Dyspnea
 Cough
 Chest wall abrasion
 Echymosis.
TREATMENT
 Oxygen administration
 Pul. Toilet
 Mechanical ventilation => in severe case

56.  Blunt and penetrating trauma
 Presented as hoarseness, SCE.
 Dyspnea , Pneumothorax , hemoptysis , Mediastinal
crunch {Hamman’s Sign},
 Intercostal retractions, Respiratory distress , Stridor.
 Chest drain will reveal a large air leak and the collapsed lung
may fail to re-expand.
• Diagnosis => Bronchoscopy
 TREATMENT Surgical repair : standard of care
 In case of airway compromise, endotracheal intubation
should be done.
 Flexible bronchoscopy permits the tube to guide distal to the
site of injury

57.  Begin with CPR
 Cover an Open Wound
 Stop bleeding
 Position the person to make breath Easier
 Monitor Breathing
 Follow up Management

58.  CAB
 INTER COSTAL DRAINGE
 PERICARDIOCENTHESIS
 SURGICAL REPAIR

59. • A. Airway
Assess for airway patency and air exchange - listen at nose & mouth
 Assess for intercostal and supraclavicular muscle retractions
 Assess oropharynx for foreign body obstruction
 Continue it till it come 100-120 compression
• B. Breathing
Assess respiratory movements of respirations - look, listen, feel and give 2 breath.
• C. Circulation
Skin - look and feel for color, temperature, capillary refill- Look for cyanosis.
 Assess pulses for quality, rate, regularity Look at neck veins - flat vs. distended-fluid
 Deficit or decreased supply to body from heart due to compression.
 Assess the Blood Pressure.

60.  It is a flexible plastic tube that is inserted through the chest
wall into the plural space.
 INDICATIONS
 -Pneumothorax:
 Tension
 Spontaneous
 Iatrogenic
 Hemothorax
 Traumatic hemopneumothorax
Empyema
Chylothorax
Bronchopleural fistula

61.  Skin preparation & marking
 Administration of anesthetic agent
 Positioning the patient
 Skin incision
 Blunt dissection down to the intercostal muscle
 Digital examination along the tract into pleural
space
 Withdrawal of central trochar & positioning of drain
 Suture taken to secure chest tube to skin
 CXR to ensure correct positioning of the chest tube
& to look for lung re expansion.

62.  CONTRA INDICATION
 Absolute…. Need for emrgency Thoracotomy
 Relatives are
 Bleeding Diathesis
 Anti-coagulation &Adhesions
 Loculations & Pulmonarybullae
 COMPLICATION
 Hemorrhage
 Infection
 Trauma to the Liver, spleen, Diaphragm, Aorta, Heart.
 Minor complications like,
 Subcut hematoma, Cough, dyspnea,
 Improper placement

64.  Using aseptic technique, Insert at least 3” needle at the angle
of the Xiphoid Cartilage at the 7th rib
 Advance needle at 45 degree towards the clavicle while
aspirating syringe till blood return is seen
 Continue to Aspirate till syringe is full then discard blood and
attempt again till signs of no more blood
 Closely monitor patient due to small amout of blood
aspirated can cause a rapid change in blood pressure

65.  THORACOTOMY – It is a surgery to open your chest. During the
procedure, a surgeon makes an incision in the chest wall between your ribs,
usually to operate lungs.
INDICATION
 Post-traumatic cardiovascular collapse
 Pericardial tamponade
 Vascular injury to the thoracic outlet
 Control of Hge from lung injury
 Massive Air leak
 Proved tracheobronchial injury
 Internal cardiac massage

66.  Emergency / Resuscitative Thoracotomy. For bleeding
control.
 Planned Thoracotomy.
 For repair of specific injury

67.  Pain
 Dyspnea
 Infection
 Bleeding
 Pneumothorax
 Respiratory Failure
 Death

68.  Chest Injuries are common and often life threatening in
trauma patients. So, Rapid identification and treatment
of these patients is paramount to patient survival.
Airway management is very important and aggressive
management is sometimes needed for proper
management of most chest injuries.

69. THANK YOU