外科学精品教学：thoracic truama.pptVIP

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 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 --- cardiac diaphragm rupture Traumatic Asphyxia Blast Injury of Lung Traumatic Asphyxia Mechanism of Injury Penetrating Trauma Stab wounds, Gunshot wounds, Impalement on a foreign body Stab wounds Penetrating Penetrating Pathophysiology(1) Hypoxemia airway obstruction changes in intrathoracic pressure hypovolemia ventilation-perfusion mismatches flail chest , chest pain Pathophysiology (2) Hypercapnia inadequate ventilation a collapsed lung exogenous intoxication Pathophysiology (3) Acidosis hypoperfusion blood loss Diagnosis Focus on: mechanism of injury patient history symptoms signs Diagnosis Supplement: chest radiograph transthoracic ultrasound pericardiocentesis Initial Treatment Top priorities: airway control adequate ventilation shock management Thoracostomy Exploration Cardiac arrest (resuscitative thoracotomy) Massive hemothorax (1500ml; 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 per