Penetrating Chest Wounds, Pneumothorax, Tension Pneumothorax - PowerPoint PPT Presentation

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Penetrating Chest Wounds, Pneumothorax, Tension Pneumothorax

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Penetrating Chest Wounds, Pneumothorax, Tension Pneumothorax and Hemothorax Gary L. Weinstein M.D. Director of Pulmonary and Critical Care Medicine – PowerPoint PPT presentation

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Title: Penetrating Chest Wounds, Pneumothorax, Tension Pneumothorax


1
Penetrating Chest Wounds, Pneumothorax, Tension
Pneumothorax and Hemothorax
  • Gary L. Weinstein M.D.
  • Director of Pulmonary and Critical Care Medicine
  • Presbyterian Hospital of Dallas
  • September 14, 2006

2
Normal Physiology
  • Breathing
  • Inspiration
  • The diaphragm contracts and moves downward
    enlarging the chest cavity
  • And the rib muscles contract, widening the chest
    cavity causing air to fill the lungs through
    suction.
  • Expiration- The diaphragm and rib muscles then
    relax, decreasing the chest size and forcing air
    out of the lungs.

3
Normal Physiology
  • Chest Wall
  • Pleura
  • Pleural Space
  • Diaphragm

4
Penetrating Chest Wounds
  • Anything that disrupts these normal relationships
    can cause problems
  • A hole in the chest, lets air collect in the
    pleural space

5
Causes
Causes
6
Causes
7
Causes
8
Causes
9
Pneumothorax
  • Pleura
  • Diaphragm

Pleura
10
Pneumothorax
  • Pneumothorax - air gets between your lungs and
    your chest wall and the lung collapses.
  • Normally, two thin layers of tissue (pleura)
    separate the lung and chest wall.
  • Any air that leaks into this space (pleural
    space) will cause the lung to collapse..

11
Pneumothorax
  • Air can collect inside the chest for many
    reasons, such as
  • An injury that damages the chest wall, such as a
    stab or gunshot wound
  • A broken rib that punctures the lung

12
Pneumothorax
  • Signs and symptoms of a pneumothorax include
  • Sudden, sharp chest pain
  • Shortness of breath
  • Chest tightness
  • Rapid pulse
  • Rapid, shallow breaths

13
Pneumothorax
  • A pneumothorax is a serious condition that can be
    life-threatening.

14
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15
Tension Pneumothorax
16
Tension Pneumothorax
  • If air continues to enter the pleural space, a
    tension pneumothorax occurs.
  • The air may compress the heart and cause a fall
    in B.P.
  • This is life-threatening and requires immediate
    treatment to release the pressure.
  • Treatment can life-saving.

17
Tension Pneumothorax
  • Symptoms of a tension pneumothorax may include
  • Shift of the trachea
  • Loss of consciousness
  • Sweating
  • Gasping
  • Shock
  • Rapid HR

18
Hemothorax
  • Blood can also collect in the pleural space and
    cause all the same signs and symptoms and
    problems as a pneumothorax including a tension
    hemothorax

19
Classical physical examination findings
The size of the injury, and position of the
patient will affect the clinical findings. For
example, a small hemothorax may have no clinical
signs at all. A moderate hemothorax will be dull
to percussion with absent breath sounds at the
bases in the erect patient, whereas signs will be
posterior in the supine patient. This is also
reflected in chest X-ray findings.
20
Assesment of patient with Blunt or Penetrating
chest trauma
  • Look
  • Determine the respiratory rate and depthLook for
    chest wall asymmetry. Paradoxical chest wall
    motion Look for bruising, seat belt or steering
    wheel marks, penetrating wounds
  • Feel
  • Feel the trachea for deviationAssess whether
    there is adequate and equal chest wall
    movementFeel for chest wall tenderness or rib
    'crunching' indicating rib fracturesFeel for
    subcutaneous emphysema
  • Listen
  • Listen for normal, equal breath sounds on both
    sides.Listen especially in the apices and
    axillae and at the back of the chest (or as far
    as you can get while supine).
  • Percuss
  • Percuss both sides of the chest looking for
    dullness or resonance (more difficult to
    appreciate in the trauma room).

21
Physical Exam in Chest Trauma
  • Trachea Chest expansion Breath
    Sounds Percussion
  • Tension Away Decreased Diminished
    or Hyper-resonant
  • Pnuemothorax Chest may be absent
  • fixed in
  • hyperexpansion
  • Simple Midline Decreased May be May be
    hyper-
  • Pneumothorax diminished resonant Usually
  • normal
  • Hemothorax Midline Decreased Diminished
    if Dull, especially
  • large Normal posteriorly
  • if small
  • Pulmonary Midline Normal Normal May Normal
  • Contusion have crackles
  • Lung Collapse/ Towards Decreased May be
    Normal
  • Atelectasis reduced

22
Hemothorax, supine
Hemothorax, upright
23

Simple Pneumothorax
24
Tension Pneumothorax
25
Examples
Stab wounds to back
Open pneumothorax
26
Treatment
  • Needle decompression
  • Simple large-bore needle
  • Mid, anterior chest
  • 2nd or 3rd rib space
  • NOT right next to Sternum

The Magic Triangle
27
Treatment
  • Asherman chest seal for Sucking Chest Wounds

28
Treatment
  • Asherman chest seal convert sucking chest
    wounds to simple pneumo/hemothorax

29
Treatment
  • Needle decompression
  • Cook Pneumothorax set

30
Treatment
  • Chest tube
  • Standard
  • Standard with Heimlich valve

Chest tube
31
Chest Tubes
32
Suction Systems
A - Suction Port/Connection C - Water Seal Fill
Port G - Suction Setting I - J - Collection
Chamber K - Suction Indicator L - Chest Tube
Connector
33
Take Home Points
  • Simple Pneumothorax/Hemothorax should be expected
    with penetrating chest wounds and rarely kills
  • Tension pneumothorax can occur rapidly
  • Tension pneumothorax can KILL rapidly
  • Treatment SAVES lives
  • Needle decompression will never harm and may
  • SAVE A LIFE!!

34
Questions?????
Drs Kumar and Weinmeister want everyone to come
to their homes tonight for Food, Drink, And
to take whatever they want!!!!
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