Background

The problem

   

Historical aspects

 

Belfast

1. •  the situation
   

2. •  what we learned
   

3. •  local guidelines
   

Organisation

  - aims

  - pre hospital care

  - hospital care

  - rehabilitation

 

 

Avoidable deaths

 

Advice for the non

  specialist

 

When to call a

  Thoracic Surgeon

Assessment

Pre-hospital care

A&E - the first glance

Resuscitation (ABC)

Secondary survey

   

 

 

Mechanisms

1. •  blunt
   

2. •  penetrating
   

3. •  blast
   

4. •  inhalation
   

5. •  crush
   

 

Specific Injuries

  - accel/deceleration

  - sternal fracture

  - shoulder

  - abdomino/pelvic

Surgery

Emergency thoracotomy 

 

Urgent thoracotomy

1. •  haemorrhage
   

2. •  mediastinal traversing
   

3. •  airleak/tracheobronchial
   

4. •  traumatic thoracotomy
   

5. •  aortic/ great vessel
   

6. •  air embolism
   

 

Associated surgery

  - thoracoabdominal

  - oesophageal

  - diaphragm

  - missile emboli

  - fractures

 

Relative contraindications

  - cardiac contusion

  - pulmonary contusion

  - pneumomediastinum

 

Flail chest

Non-surgical management
  Intensive care
  - oxygenation
  - pain relief
  - secretions
 
  Interventions
  - ventilation
  - chest drains
  - bronchoscopy
  - minitracheostomy
  - tracheostomy
  - IABP/ECMO
  - decortication/rib fixation
 
  Paediatric trauma
 
  Sequelae
  - haemothorax/empyema
  - chest wall
  - contusion
 
  Medicolegal aspects
 
  References