PHTLS - Thoracic Trauma (CH12), PHTLS
Pretest, PHTLS pretest 8th edition, PHTLS
8th Test
Thoracic Trauma -
Rib Fractures (pathophysiology) - ANS Upper ribs are broad, thick and particularly well
protected by the shoulder girdle and muscles. Requires great energy to fracture the upper ribs
and the patient is at risk for significant injuries such as traumatic disruption of the aorta.
Rib fractures occur most often to Ribs 4-8 laterally, where they are thin and have less over lying
musculature.
Broken ends of ribs may tear muscle, lung and blood vessels with possibility of an associated
pulmonary contusion.
Simple rib fractures are rarely life threatening in adults, and may be deadly in the elderly patient.
Compression of the lung may rupture the alveoli and lead to pneumothorax.
Fracture of the lower ribs may be associated with injuries of the Spleen and Liver and may
indicate the potential for intra-abdominal injuries. These injuries may also present with signs of
blood loss or shock.
Thoracic Trauma -
Flail Chest - ANS
Thoracic Trauma -
Pneumothorax (Simple, Open, Tension) - ANS
Thoracic Trauma -
Pulmonary Contusion - ANS
Thoracic Trauma -
Hemothorax - ANS Pathophysiology - Occurs when blood enters the pleural space. Because
this space can accommodate a large volume of blood (2500-3000 ml), hemothorax can
represent a source of significant blood loss and the loss of this circulating blood volume into the
pleural space is a greater physiologic insult to the patient than the collapse of the lung that the
hemothorax produces.
, Assessment:
Presentation - some distress, chest pain and SOB are prominent features, generally signs of
significant shock (tachycardia, tachypnea, confusion, pallor and hypotension.) Breath sounds on
the side of injury are diminished or absent (percussion note is DULL).
Pneumothorax may be present in conjunction with hemothorax, increasing the likelihood for
cardiorespiratory compromise.
**Because of loss of circulating blood volume, JVD often is NOT present.
Management:
Constant observation to detect physiologic deterioration while providing appropriate support.
High flow O2
Ventilation support via BVM or ETT if indicated.
Hemodynamic status monitored.
IV access an appropriate fluid therapy provided with a goal of maintaining adequate perfusion
without large volumes (SBP 80-90)
Rapid Transport to appropriate facilities for surgical intervention.
Thoracic Trauma -
Blunt Cardiac Injury - ANS
Thoracic Trauma -
Cardiac Tamponade - ANS
Thoracic Trauma -
Commotio Cordis - ANS
Thoracic Trauma -
Traumatic Aortic Disruption - ANS
Thoracic Trauma -
Tracheobronchial Disruption - ANS
Thoracic Trauma -
Traumatic Asphyxia - ANS
Thoracic Trauma -
Diaphragmatic Rupture - ANS
Thoracic Trauma -
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