Rapid accumulation of 1500 mL o blood in the chest cavity.
Hypoxia
Neck veins may be flat secondary to hypovolemia
Absence of breath sounds andor dullness to percussion on one side of the chest
Management: Restoration of blood volume and decompression of the chest
cavity.
Indication of thoracotomy: a. Immediately 1500 mLof blood evacuated. b. 200mLhr for 2-4 hrs. c. Patient’s physiology status. d. Persistent blood
transfusion requirements.
2. Cardiac Tamponade
Cardiac tamponade is usually due to penetrating cardiac injuries and are a
leading cause of traumatic death.
Diagnosis : Cardiac tamponade requires prompt recognition and treatment. Signs and symptoms range from rarely stable to Beck’s triad of hypotension, CVP
above 12cc of water and muffled heart sounds
Auscultation of the thorax is performed specifically to evaluate the clarity of
heart tones and breath sounds. Muffled heart tones are an indication of blood in the pericardium. A systolic - to diastolic gradient of less then 30 mmHg,
associated with hypotension is consistent with cardiac tamponade.
Neck veins are distended. Central venous pressure is elevated.
The X-ray film may demonstrate a widening of the cardiac silhouette. The ultrasound
scan shows presence of blood in pericardial space.
Electrocardiograph is not particularly helpful.
Prompt definitive therapy is imperative. This includes antishock therapy, pericardiocentesis possibly under U.S. guide, emergency thoracotomy and suture of the
wound.
3. Tension Pneumothorax
Tension pneumothorax develops when air enters the pleural space but cannot exit and as
a result there is a progressively increasing intrathoracic pressure in the affected hemithorax resulting in impaired central venous return and mediastinal shift.
Clinically, the patient experiences dyspnea, complains of chest pains, and becomes
cyanotic because of shunting in the collapse of lung and has hemodynamic instability because decrease is venous return for endopleural hypertension.
The presence of hyper-resonance and the absence of breath sounds, together with X-ray
examination, should be useful in confirming the cause of the emergency.
A chest X-ray film indicates that the trachea and mediastinum are deviated to the side opposite the tension pneumothorax, while on the ipsilateral side intercostal spaces are
widened and the diaphragm is pushed downward.
The emergency require immediate thoracosintesis and thoracostomy with underwater-
seal drainage.
4. Blunt Abdominal trauma
