Pathophysiology of Thoracic Тrauma
uBlunt Trauma
–Results from kinetic energy forces
–Subdivision Mechanisms
uBlast
–Pressure wave causes tissue disruption
–Tear blood vessels & disrupt alveolar tissue
–Disruption of tracheobronchial tree
–Traumatic diaphragm rupture
uCrush (Compression)
–Body is compressed between an object and a hard surface
–Direct injury of chest wall and internal structures
uDeceleration
–Body in motion strikes a fixed object
–Blunt trauma to chest wall
–Internal structures continue in motion
uLigamentum Arteriosum shears aorta
–Age Factors
uPediatric Thorax: More cartilage = Absorbs forces
uGeriatric Thorax: Calcification & osteoporosis = More fractures
uPenetrating Trauma
uPenetrating Trauma
–Low Energy
uArrows, knives, handguns
uInjury caused by direct contact and cavitation
–High Energy
uMilitary, hunting rifles & high powered hand guns
uExtensive injury due to high pressure cavitation
–Shotgun
uInjury severity based upon the distance between the victim and shotgun & caliber of shot
uType I: >7 meters from the weapon
–Soft tissue injury
uType II: 3-7 meters from weapon
–Penetration into deep fascia and some internal organs
uType III: <3 meters from weapon
–Massive tissue destruction
Injuries Associated with Penetrating Thoracic Trauma
uClosed pneumothorax
uOpen pneumothorax (including sucking chest wound)
uTension pneumothorax
uPneumomediastinum
uHemothorax
uHemopneumothorax
uLaceration of vascular structures
uTracheobronchial tree lacerations
uEsophageal lacerations
uPenetrating cardiac injuries
uPericardial tamponade
uSpinal cord injuries
uDiaphragm trauma
uIntra-abdominal penetration with associated organ injury