VENTILATION AND CHEST INJURIES

DR ADENIRAN
• Chest injuries is a significant cause of mortality
thus many are treatable.
• A protected unobstructed airway and
adequate ventilation are critical to prevent
hypoxemia.
Physiological consequences of chest injuries

• Hypoxia
• Hypercarbia
• Acidosis
• Hypoxia is the most serious consequences of
chest injuries,the goal of early intervention is
to prevent or correct hypoxia
 OBJECTIVE SIGNS OF INADEQUATE
VENTILATION
• 1. look for symmetrical rise and fall of the
chest and adequate chest wall excursion
• 2. listen for movement of air on both sides of
the chest.
• 3. use a pulse oximeter to measure the
patients oxygen saturation and perfusion
 MANAGEMENT OF VENTILATION
• Effective ventilation can be achieved by bagmask technique
• Using 2 person bagmask techniques is very effective.
• Intubation of patients with hypoventilation or apnea may
not be successful initially and may require multiple
attempts
• The patient is ventilated periodically during prolong effort
to intubate.
• Maintain oxygenation and ventilation before,during,and
immediately upon completing insertion of the definitive
airway.
Potentially life threatening injuries
• 1. simple pneumothorax
• 2. massive hemothorax
• 3. flair chest and pulmonary contusion
• 5. blunt cardiac injury
• 6. traumatic aortic disruption
• 7.traumatic diaphragmatic injury
• 8. blunt esophageal rupture
 Simple pneumothorax
• Air entering the potential space between the
visceral and parietal pleura resulting in
collapse of the affected lungs.
• Caused by lung laceration
• BS –dec on affected side ,hyperresonance
• Chest tube can be passed
 Massive hemothorax
• Blood accumulates in the pleural cavity
• >1500mls
• Dullness to percuss ,reduced bs
• Tracheal Deviation
 Flail chest and pul contusion
• this occurs when a segment of the chest wall
does not have bony continuity with the rest of
the thoracic cage.
• Assoc with multiple rib fracture .
• Contusion is a bruise of the lung
• Dec Bs, abn respiratory effort ,hypoxia.
• Abn Spo2
 Primary survey
• Look for evidence of air hunger,intercoastal recession etc
• Chest movement for adequacy of respiration
• Listen for air movement at the patient nose,mouth, and lungfield.
Also equal breathe sound
• Listen for evidence of partial upper airway obstruction or voice
quality
• Feel for crepitation over the anterior neck,palpate to determine if
area of tenderness etc
• Expose the patient chest and neck ---assess the neck veins and
breathing
• Check for centrality of the trachea
• Percuss for dullness
 CHEST TUBE INSERTION
• Chest tube drains fluid ,fluid,or air from
around the lungs,.
• The tube is placed around the lungs between
the ribs and into the space between the inner
lining of the chest cavity and outer lining this
is called the pleural space
 Indications of chest tube
• Pneumothorax
• Pleural collection such as pus,blood,etc
• Postoperative
• Thoracotomy
• Thoracoscopic surgery