PenetratingBluntCardiac contusionCardiac TamponadeDiaphragm RuptureEsophageal injury

Rib fracturesPneumothoraxHemothoraxTension pneumothoraxFlail chestPulmonary contusion

Oxygen therapyChest tube – 80% of chest trauma (blunt and penetrating) only requires a chest tube

Don’t want to Dx Tension PTX with Chest x-ray!

Requires immediate diagnosis and treatmentDiminished breath sounds, tracheal deviation, hypotensionAngio cath 2nd intercostal space midclavicular lineFollowed by chest tube

Mild < 400 cc bloodModerated 400-1000Massive > 1000

Place Chest tubeMay require ORRemember retained hemothorax a bad complication

Pain control, pain control, pain controlMay require intubation of respiratory distressChest tube may be requiredEpidural evaluation

Pulmonary Contusion

This is an injury that doesn’t look as bad as it means clinicallyPain controlOxygen therapyLimit fluid intakeMay require intubation

Remember:•The Chest is connected to the abdomen.•The margins of the abdomen are the lower margin of the scapula and the gluteal fold.•Intrathoracic may mean intraabdominal•Sternal Fx, First rib Fx, Scapular Fx indication major blunt for to chest•Associated TBI

Incredibly painfulPain control and pulmonary toilet mainstay of therapyRespiratory care consultIncentive SpirometeryEarly mobilization

Rib Fracture

FVC < 1000 FVC 1000-1500 FVC > 1500

Admit ICU Admit SDU Admit Floor

Respiratory care consultCPAP if FVC <500NebulizersIS q1 hrPEP q 2 hrPercuss and vibrate q 2 hrDaily chest x-rayTotal Sports BedEpidural Continuous pulse ox

Respiratory care consultFVC q 8 hrIf falls below 1000 – ICUNebulizers as neededIS q 1 hr while awakePEP q 4 hrPercuss and vibrate q 2 hrEpiduralContinuous pulse ox

Respiratory care consultIS q 1 hr while awakePEP q 4 hrPulse ox with vital signs

NSAIDSToradolNarcoticsPCARib BlocksEpiduralLocal Infusion cathetersKetamine

•Barium strip on side•Sentinal hole must be within the chest cavity•Occlusive dressing•Suction vs. waterseal

1. Chest tube with or without trocar2. Chest tube suction unit (Pleurevac), tubing, wall suction hookup3. Chest tube tray to include scalpel blade and handle, large Kelly clamps, needle driver, scissors4. Packet of 0 or 1 silk suture on a curved needle5. Tape, gauze6. Lidocaine with or without epinephrine, 20 cc syringe, assortment of gauged needles for infiltration (18, 23)7. Sterile prep solution; mask, gown and gloves8. IV pain medicine

WatersealSuction◦

20 cm wet suction◦

40 cm dry suction