胸外伤ThoracicTrauma.ppt

Thoracic Trauma 医大二院胸外科 Classification and pathophysiology closed trauma 1) soft tissue bruise 2) rib fracture 3) hemothorax 4) pneumothorax 5) hemopneumothorax 6) hemopericardium 7) traumatic asphyxia 8) blast injury of lung open trauma Pneumothorax hemothorax effect of the function of respiration and circulation thoracic-abdominal injury Clinic manifestation chest pain: the most chief symptom dyspnea 1) chest pain 2) block of trachea 3) pneumochysis 4) flail chest 3. breathlessness, orthopnea, dysphoria4. blood sputum or hemoptysis 5. shock serious bleeding of intrathorax a large quantity of air in thoracic cavity (especially tension pneumothorax) hemopericardium 6. local signs chest wall bruise paradoxical motion subcutaneous emphysema tenderness shift of trachea and heart percussion: tympanic resonance or dull resonance auscultation: distant breath sound or absent breath sound Diagnosis injured history and manifestation pleurocentesis roentgenogram Treatment stop (relieve) pain fixation chest wall debridement and suture of wound thoracentesis and tube thoracostomy thoracotomy for active bleeding use antibiotic to preventing infection Conditions requiring urgent thoracotomy continued intrapleural bleeding massive air leak acute or rapidly recurring pericardial tamponade thoraco-abdominal injury massive foreign matter retained in thorax RIB FRACTURE rib fracture is the most common disease of all thoracic trauma 4~7 ribs are longer and fixed, so they are easy to be broken etiology direct or indirect violence to the chest pathologic fracture pathophysiology pneumothorax, hemothorax flail chest, paradoxical movenent clinic manifestation pain, cough, dyspnea inspectation sign: 1) swollen 2) tenderness 3) bony crepitus 4) paradoxical movement 5) subcutaneous emphysema chest roentgenogram treatment closed and single rib fracture: stop pain, fixation and prevent complication flail chest: 1