ATLS, Chapter 4: Thoracic TraumaLunch and Learn 6 Jan2009

Topics Primary survey

Airway obstructionTension pneumothoraxOpen pneumothoraxFlail ChestHemothoraxCardiac tamponade

Secondary SurveyIdentify and treat

Simple pneumothoraxHemothoraxPulmonary contusionTracheobronchial disruptionBlunt cardiac injuryTraumatic aortic disruptionDiaphragmatic injury

Primary surveyYou must treat hypoxia in your primary survey, if no ariway and oxygenation established, don’t move on to your secondary survey!

Primary SurveyEstablish airway: intubate or

cricothyroidotomy.Breathing:

Confirm tube placementAuscultate lungs: this is when you will pick up

pneumothoraces, flail chest, hemothorax.

Primary SurveyTension pneumothorax Immediate tx?

Definitive tx?

Primary SurveyOpen pneumothorax

Treatment? Immediate, definitive?

Primary SurveyFlail Chest: 2 ribs, broken in 2 places. Paradoxical motion?

Treatment?

Immediate?

Long term?

Primary SurveyCirculation:

Hemothorax

Vital signs?

Massive >1500ml, requires thoracotomyTreatment? Immediate?

Primary SurveyCirculation

Cardiac tamponade-what happens?

Beck’s triad?

Pulsus paradoxus: decrease in SBP >10 during inspiration

Immediate dx and tx: pericardiocentesis vs ultrasound.

Will require thoracotomy.

Secondary SurveyIncludes all xrays, ABGs, FAST, labs, etc.Should have definitive airway at this point

and IV’s.Looking for areas of bleeding in closed

cavities, fractures, etc.

Secondary Survey: ThoracicSimple pneumothorax

May discover on chest x-ray

Secondary Survey

Hemothorax: tx with CT

Secondary SurveyPulmonary contusion:

persistent hypoxiaTracheobronchial tree injury:

hemoptysis, subcutaneous emphysema, tension pneumo

Blunt cardiac injury: may show ECG abnormalities, at risk for dysrhythmias.

Aortic ruptureTraumatic diaphragmatic

injury.

Other Manifestations of Chest InjuriesSubcutaneous emphysema: probably will

need chest tube, especially if intubating.Rib, sternum, Scapular fx: severe injuries,

think about trauma to underlying organs and vessels, spinal injury.

Esophageal trauma: gastric contents empty into thoracic cavity. Will require thoracotomy and repair.