胸部外伤精选文档Incidenceandmortality发生率和死亡率:Chesttraumaaccountsfor8%occurrencesoftotaltraumaticcases,morethan25%ofdeathcausedbytrauma.胸外伤病因ResultsfromkineticenergyforcesBlast（爆破伤）PressurewavecausestissuedisruptionTearbloodvessels&disruptalveolartissueDisruptionoftracheobronchialtreeTraumaticdiaphragmruptureCrush(Compression)（挤压伤）BodyiscompressedbetweenanobjectandahardsurfaceDirectinjuryofchestwallandinternalstructuresDeceleration（减速伤）BodyinmotionstrikesafixedobjectBlunttraumatochestwallInternalstructurescontinueinmotionLigamentumArteriosumshearsaortaLowEnergyArrows,knives,handgunsInjurycausedbydirectcontactandcavitationHighEnergyMilitary,huntingrifles&highpoweredhandgunsExtensiveinjuryduetohighpressurecavitation穿透伤合并损伤TracheobronchialtreelacerationsEsophageallacerationsPenetratingcardiacinjuriesPericardialtamponadeSpinalcordinjuriesDiaphragmtraumaIntra-abdominalpenetrationwithassociatedorganinjuryRibFractures>50%ofsignificantchesttraumacasesduetoblunttraumaCompressionalforcesflexandfractureribsatweakestpointsRibs1-3requiresgreatforcetofracturePossibleunderlyinglunginjuryRibs4-7aremostcommonlyfracturedRibs11-12lesslikelytobefracturedTransmitenergyoftraumatointernalorgansIffractured,suspectliverandspleeninjuryHypoventilation（肺换气不足）isCOMMONduetoPAINSternalFracture&Dislocation（胸骨骨折和错位）AssociatedwithseverebluntanteriortraumaDirectBlow(比如：方向盘)Incidence:5-8%Mortality:25-45%Myocardialcontusion（心肌的钝挫伤）Pericardialtamponade（心包填塞）Cardiacrupture（心脏破裂）Pulmonarycontusion（肺挫伤）DislocationuncommonbutsameMOIasfractureTracheal（气管）depressionifposteriorFlailChest(连枷胸)SegmentofthechestthatbecomesfreetomovewiththepressurechangesofrespirationThreeormoreadjacent（毗邻的）ribfractureintwoormoreplacesSeriouschestwallinjurywithunderlyingpulmonaryinjury（潜在的肺损伤）ReducesvolumeofrespirationAddstoincreasedmortalityParadoxicalflailsegmentmovement（反常呼吸运动）Positivepressureventilation（通气）canrestoretidalvolume（潮气量）Pulmonaryinjuryandinjuriesinvolvingthepleural