Blunt Chest Trauma

Chest Trauma Chest trauma is classified as either blunt or penetrating. 1. Blunt Chest Trauma I. Definition a. Blunt chest trauma results from sudden compression or positive pressure inflicted to the chest wall. Motor vehicle crashes (trauma due to steering wheel, seat belt), falls, and bicycle crashes (trauma due to handle bars) are the most common causes of blunt chest trauma. II. Pathophysiology Injuries to the chest are often life-threatening and result in one or more of the following pathologic mechanisms: * Hypoxemia from disruption of the airway; injury to the lung parenchyma, rib cage, and respiratory musculature; massive hemorrhage; collapsed lungs; and pneumothorax * Hypovolemia from massive
Pneumothorax I. Definition a. Pneumothorax occurs when the parietal or visceral pleura is breached and the pleural space is exposed to positive atmospheric pressure. Normally the pressure in the pleural space is negative or subatmospheric compared to atmospheric pressure; this negative pressure is required to maintain lung inflation. II. Types of pneumothorax * Simple Pneumothorax – also known as spontaneous pneumothorax occurs when air enters the pleural space through a breach of either the parietal or visceral pleura. Most commonly this occurs when air enters the pleural space through a rupture of the bleb or a bronchopleural fistula. It may be associated with diffuse interstitial lung disease and severe emphysema. * Traumatic Pneumothorax – occurs when air escapes through a laceration in the lung itself and enters the pleural space or enters the pleural space through a wound in the chest wall. It can occur with blunt trauma or penetrating trauma. Traumatic pneumopthorax resulting from major injury to the chest is often accompanied by hemothorax. Often blood and air are found in the chest
It may be a complication of other types of pneumothorax. III. Pathophysiology b. In open pneumothorax, air enters the chest during inspiration and expiration. A slight shift of the affected lung may occur because of a decrease in pressure as air moves out of the chest. c. In tension pneumothorax, air enters but cannot leave the chest. As the pressure increases, the heart and the great vessels are compressed and the mediastinal structures are shifted toward the opposite side of the chest. The trachea is pushed from its normal midline position toward the opposite side of the chest, and the unaffected lung is compressed. IV. Clinical