胸部外伤ppt课件_9.ppt

胸外伤进展; Incidence and mortality: Chest trauma accounts for 8% occurrences of total traumatic cases, more than 25% of death caused by trauma.; 胸外伤病因;Results from kinetic energy forces Blast（爆破伤） Pressure wave causes tissue disruption Tear blood vessels & disrupt alveolar tissue Disruption of tracheobronchial tree Traumatic diaphragm rupture Crush (Compression)（挤压伤） Body is compressed between an object and a hard surface Direct injury of chest wall and internal structures Deceleration（减速伤） Body in motion strikes a fixed object Blunt trauma to chest wall Internal structures continue in motion Ligamentum Arteriosum shears aorta ; Low Energy Arrows, knives, handguns Injury caused by direct contact and cavitation High Energy Military, hunting rifles & high powered hand guns Extensive injury due to high pressure cavitation ;穿透伤合并损伤;Tracheobronchial tree lacerations Esophageal lacerations Penetrating cardiac injuries Pericardial tamponade Spinal cord injuries Diaphragm trauma Intra-abdominal penetration with associated organ injury;; ; ;Rib Fractures >50% of significant chest trauma cases due to blunt trauma Compressional forces flex and fracture ribs at weakest points Ribs 1-3 requires great force to fracture Possible underlying lung injury Ribs 4-9 are most commonly fractured Ribs 9-12 less likely to be fractured Transmit energy of trauma to internal organs If fractured, suspect liver and spleen injury Hypoventilation is COMMON due to PAIN;Sternal Fracture & Dislocation （胸骨骨折和错位） Associated with severe blunt anterior trauma Direct Blow (比如：方向盘) Incidence: 5-8% Mortality: 25-45% Myocardial contusion Pericardial tamponade Cardiac rupture Pulmonary contusion Dislocation uncommon but same MOI as fracture Tracheal depression if posterior ;Flail Chest(连枷胸) Segment of the chest that becomes free to move with the pressure changes of respiration Three or more adjacent rib fracture in two or more places Serious chest wall injury with underlying pulmonary in