Penetrating chest trauma (mechanism of disease)

ERRATA: Significant omission: Vascular injury (such as to the aorta or vena cava) can also cause hypovolemic (hemorrhagic) shock. This is a flowchart on penetrating chest trauma, covering the etiology, pathophysiology, and manifestations. ADDITIONAL TAGS: Diaphragmatic hernia Risk factors / SDOH Cell / tissue damage Structural factors Medicine / iatrogenic Infectious / microbial Pressure physiology Immunology / inflammation Signs / symptoms Tests / imaging / labs Environmental / exposure Cancer / neoplasm Cardiorespiratory pathology Pathophysiology Etiology Manifestations Thrusting action of a pointed object (e.g., knife, broken bottle) Tissue is lacerated and torn along the path of the object Stab wounds: Depth of injury usually greater than the width Tissue is lacerated and crushed along the path of the bullet Gun shot wounds: Tissue displaced forward and radially → cavitation and pressure injury of nearby structures. Dense organs (liver, bone) absorb more kinetic energy than less dense organs, resulting in greater injury Severity of injury is related to the kinetic energy of the bullet (i.e., weight, velocity) Penetrating chest trauma: open wound injury with deep but relatively narrow entry wound Cardiac tamponade: ↑ intrapericardial pressure from pericardial effusion → compression of heart Hemothorax: blood in the pleural cavity Pneumothorax: pleural cavity air → lung collapse Tracheobronchial injury Diaphragmatic injury Spinal cord injury Fractures (rib, vertebral) Hypotension Muffled heart sounds ↑ JVP → Distended neck veins Tachycardia, pulsus paradoxus Pallor, cold sweats Left heart failure Right heart failure Peripheral edema Hepatojugular reflux Hepatosplenomegaly Jugular venous distension Obstructive shock Hemorrhagic shock Respiratory distress, hypoxia Chest pain ↓ or absent breath sounds ↓ tactile fremitus Dullness on percussion Flat neck veins Distended neck veins, tracheal deviation Tension pneumo. Obstructive shock Beck’s triad Dyspnea Sternal tenderness Subcutaneous emphysema Hoarseness, dysphonia Bloody tracheal secretions CXR: air in surrounding soft tissue Bowel obstruction Dyspnea; ↓ breath sounds; bowel sounds in chest Obstipation: complete inability to pass stool or gas Sensory and/or motor disturbances below the level of injury Local pain on pressure, percussion, compression, inspiration =3 ribs in =2 places → Flail chest with paradoxical movement Acute dyspnea, orthopnea (worse when supine) Hypotension, tachycardia Coughing or wheezing, coarse crackles/rales Weak, fatigue, AMS, cold, clammy, cyanosis Penetrating chest trauma Progressively ↑ pressure within chest