Chest and lung injury
6 killers in the chest
- Airway obstruction or disruption
- Tension pneumothorax
- Open pneumothorax
- Massive haemothorax
- Flail chest
- cardiac tamponade
| Injury | Recognition | Immediate/prehosp management: Deliver as much oxygen as possible, and... |
Ongoing management |
|---|---|---|---|
| Airway obstruction/disruption | ➥ Neck deformity/ haematoma ➥ Crepitus, surgical emphysema ➥ stridor ➥ hypoxia, cyanosis |
Simple airway manoeuvres initially | Intubate - oral or through neck wound? Tracheostomy? |
| Tension pneumothorax | ➥ Obstructive shock Distended neck veins ↓ chest movement |
Needle decompression - 2nd ICS mid-claviular line or 5th ICS mid-axillary line? | Chest drain |
| Open pneumothorax | Open wound As with pneumothorax - ↓ chest movement, hyper-resonance |
Russell chest seal or similar | Chest drain in separate intercostal space |
| Massive haemothorax (massive = requires thoracotomy) | ➥ shock ➥ ↓ chest movement ➥ blood in chest tube... |
➥ as with Impending bleeding doom ➥ Chest tube if not already present ➥ Thoracotomy |
|
| Flail chest | Analgesia as per rib fractures | Surgical fixation? | |
| Cardiac tamponade | Obstructive shock Distended neck veins |