外科医学课件：thoracic truama 胸部损伤

1、THORACIC TRAUMA,胸 部 损 伤,Key Words,Chest Wall Pleura Thoracic Cavity Pleural Space Intrapleural Pressure,Thoracic Cavity Pleural Space,Thoracic injuries account for 20% to 25% of all trauma-related deaths, and complications of chest trauma contribute to another 25% of all deaths.,Many of these deaths

2、 can be prevented with prompt diagnosis and correct management.,Classification,Blunt Trauma Penetrating Trauma Thoraco-Abdominal Trauma,Mechanism of Injury,Blunt Trauma A direct blow to the chest - rib fracture Deceleration injury - pulmonary or cardiac contusion, aortic tear Compression injury - ca

3、rdiac 200-300ml/hr) Penetrating injuries of the anterior aspect of the chest with cardiac tamponade Large open wounds of the thoracic cage Major thoracic vascular injuries in the presence of hemodynamic instability Major tracheobronchial injuries Evidence of esophageal perforation,Emergency Room Tho

4、racotomy,Rib Fractures,Rib Fractures,Fracture of the ribs is the most common thoracic injury. Most common on the 4-7th rib.,Simple Fracture,Symptom -pain on inspiration Consequence -hemothorax, pneumothorax,Simple Fracture,Diagnosis: chest X-ray Treatment: pain relief, cough assistance, fixation (no

5、t always needed),Simple Fracture,Flail Chest,Two or more fractures in three or more consecutive ribs Costochondral separation Causes instability of the chest wall,Flail Chest,Thoracic cage instability paradoxical respiratory motion hypoventilation,Flail Chest,French peasants threshing with flails ar

6、ound 1270.,A flail is an agricultural tool used for threshing to separate grains from their husks.,Flail Chest,Flail Chest,On inspiration,On expiration,Flail Chest,Clinical Manifestations,Severe chest pain, Dyspnea, Paradoxical respiratory motion, Hypoxia,Management,Excellent pain relief Endotrachea

7、l suction, intubation External fixation Open reduction and internal fixation Mechanical ventilation with PEEP,Pneumothorax,An accumulation of gas in the pleural space,Pneumothorax,Results from: lacerations of the chest wall or lung rupture of an alveoli Caused by: penetrating or blunt trauma,Classif

8、ication,Closed pneumothorax, Open pneumothorax Tension pneumothorax,Closed pneumothorax,the most common type,Closed pneumothorax,Open pneumothorax,Intrapleural pressure rises Lung collapse Mediastinal shift,Open pneumothorax,On inspiration,On expiration,Open pneumothorax,Tension Pneumothorax,A flap

9、valve leak allows air to enter the pleural space but prevents its escape,Tension pneumothorax,On inspiration,On expiration,Tension pneumothorax,Intrapleural pressure rises Lung collapse Mediastinal shift Impediment of venous return Impairment of cardiac function,Tension pneumothorax,Manifestation,Su

10、bcutaneous emphysema Absent breath sounds Mediastinal shift Acute respiratory distress,Subcutaneous emphysema,Initial Treatment,Pressure relief Large-bore needle insertion Chest tube insertion,Blood in the pleural space,Hemothorax,Hemothorax,Hemorrhage into the pleural space Sources: pulmonary tissu

11、e or vascular intercostal arteries heart or aorta rupture,Hemothorax,Manifestations,Blood loss, Shock Compression, Mediastinal shift Infection,Hemothorax,Subsequente Results: Clotted hemothorax Fibrothorax Empyema,Hemothorax,Managements: Thoracentesis Chest tube drainage Thoracostomy,Indications for thoracostomy,Unrelenting hemorrhage following either penetrating or blunt thoracic trauma An initial thoracic blood loss greater than 1500ml (30% blood volume),Indications for thoracosto