Dealing with Critical Situations Tension Pneumothorax Flail Chest

Dealing with Critical Situations Tension Pneumothorax & Flail Chest Dr Tanveer sadiq chaudhry Associate professor surgery MBBS Medical college, Mirpur

Pneumothorax the presence of air or gas in the cavity between the lungs & the chest wall, causing lung collapse.

Pneumothorax on CXR

Tension Pneumothorax (4 � The accumulation of air under pressure in the pleural space. � The lung will collapse under the pressure. � High air pressure than atmospheric pressure, compresses the lung, displace the mediastinal structures toward the opposite side � Cardiopulmonary impairment & later arrest

� Tension pneumothorax causes lung collapse, mediastinal shift, superior vena cava (SVC) compression and ultimate mechanical failure of heart and lung timely evaluation with intervention can avoid fatal outcome

Tension right pneumothorax

Needle Thoracostomy 1. 2. 3. 4. 5. 6. 7. Large bore needle with catheter 14 -16 G 2 nd intercostal space at midclavicular line 12 cm lateral to sternal angle (IMA) Prepare area with poyodine Insert needle superior to 3 rd rib Insert needle to chest wall 3 -6 cm in depth Stop advancement on pressure release of pleural space Remove needle, leave catheter in place

TUBE THORACOSTOMY � Drainage of the pleural space by chest tube � provides the definitive treatment for majority of cases. � By and large it is a safe, quick, economic and highly rewarding procedure � Complications in 2 - 10 %.

triangle of safety anteriorly latissimus dorsi laterally pectoralis major muscle line superior to the horizontal level of the nipple apex below the axilla.

TECHNIQUE OF TUBE THOROCOSTOMY: tube is inserted in the triangle of safety. � The procedure is performed under local anesthetic agent lignocaine � The area cleaned & draped � stab incision is made along the superior border of the rib below � The skin incision sufficient to admit the operator’s finger � The intercostals muscles are slit � The tube is inserted, stylette withdrew as soon as the pleural space is entered � underwater seal and sutured in place � A CXR to confirm placement and position � The

Post Chest intubation CXR

Thoracic injuries � Most important aspects directly accounting for 20 -25 % of all trauma related deaths � Playing major contributing role in another 25% of trauma deaths. � involve healthy young adults who happen to be the bread earners for their families. � Falls from heights, blasts, and miscellaneous acts of violence are other causative mechanisms

� Thoracic trauma comprises a broad spectrum of injuries and severity. � The thorax is responsible for delivering oxygenated blood to metabolically active tissues � Space occupying lesions of pleural space such as pneumothorax cause compressive collapse of the lung and interfere with oxygenation.

Flail chest

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