1 Thoracic Trauma
2 ◼ Thoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting organs inside the thorax (the chest) excluding the heart. ◼ Generally treatment of conditions of the lungs, chest wall, esophagus and diaphragm. ◼ Thoracic surgery is often grouped with cardiac surgery and called cardiothoracic surgery (primarily in the United States). Thoracic Surgery
3 Anatomy and Physiology of the Thorax ◼ Thoracic Skeleton ◼ 12 Pair of C-shaped ribs ◼ Ribs 1-7: Join at sternum with cartilage end-points ◼ Ribs 8-10: Join sternum with combined cartilage at 7th rib ◼ Ribs 11-12: No anterior attachment ◼ Sternum ◼ Manubrium ◼ Joins to clavicle and 1st rib ◼ Jugular Notch ◼ Body ◼ Sternal angle (Angle of Louis) ◼ Junction of the manubrium with the sternal body ◼ Attachment of 2nd rib ◼ Xiphoid process ◼ Distal portion of sternum
4 Anatomy and Physiology of the Thorax ◼ Thoracic Skeleton ◼ Topographical Thoracic Reference Lines ◼ Midclavicular line ◼ Anterior axillary line ◼ Mid-axillary line ◼ Posterior axillary line ◼ Intercostal space ◼ Artery, Vein and Nerve on inferior margin of each rib ◼ Thoracic Inlet ◼ Superior opening of the thorax ◼ Curvature of 1st rib with associated structures ◼ Thoracic Outlet ◼ Inferior opening of the thorax ◼ 12th rib and associated structures & Xiphisternal joint
5 Anatomy and Physiology of the Thorax ◼ Trachea, Bronchi & Lungs ◼ Trachea ◼ Hollow & cartilage supported structure ◼ Bronchi ◼ Right & left extend for 3 centimeters ◼ Enters lungs at Pulmonary Hilum ◼ Also where pulmonary arteries & veins enter ◼ Further subdivide and terminate as alveoli ◼ Basic unit of structure & function in the lungs ◼ Single cell membrane ◼ External versus Internal Respiration ◼ Lungs ◼ Right = 3 lobes ◼ Left = 2 lobes
6 Anatomy and Physiology of the Thorax ◼ Mediastinum ◼ Central space within thoracic cavity ◼ Boundaries ◼ Lateral: Lungs ◼ Inferior: Diaphragm ◼ Superior: Thoracic outlet ◼ Structures ◼ Heart ◼ Great Vessels ◼ Esophagus ◼ Trachea ◼ Nerves ◼ Vagus ◼ Phrenic ◼ Thoracic Duct
7 ◼ Chest trauma (or thoracic trauma) is a serious injury of the chest. ◼ Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury. ◼ Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all trauma-related deaths. ◼ The mortality rate is about 10%. Thoracic Trauma
8 Classification ◼ Chest trauma can be classified as blunt or penetrating. ◼ Blunt and penetrating injuries have different pathophysiologies and clinical courses. ◼ Specific types of chest trauma include: (1)Injuries to the chest wall ◼ Chest wall contusions or hematomas. ◼ Rib fractures ◼ Flail chest ◼ Sternal fractures ◼ Fractures of the clavicle and shoulder girdle
9 (2)Pulmonary injury (injury to the lung) and injuries involving the pleural space ◼ Pulmonary contusion ◼ Pulmonary laceration ◼ Pneumothorax ◼ Hemothorax ◼ Hemopneumothorax (3)Injury to the airways ◼ Tracheobronchial tear
10 ◼ Most blunt injuries are managed with relatively simple interventions like intubation and mechanical ventilation and chest tube insertion. ◼ Diagnosis of blunt injuries may be more difficult and require additional investigations such as CT scanning. ◼ Penetrating injuries often require surgery, and complex investigations are usually not needed to come to a diagnosis