Chest injuries

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1. CHEST

2. 2
Anatomy

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Overview of Chest Injuries
Can be life-threatening
May result in damage to either the heart or the lung and
cause severe internal bleeding
Rib cage fractures may result in serious injury to vital
organs
Deep, open wounds allow air to enter the chest cavity
Closed wounds usually involve injury to the ribs and
possibly underlying structures

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Signs of Chest Injuries
An obvious chest wound
Impaired breathing
Irregular – or lack of – chest expansion
Coughing-up of blood
Shock
Subcutaneous emphysema: crackling sensation

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Closed Chest Injuries
Rib fracture
Flail chest
Pneumothorax

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Rib Fracture
Rib fractures are almost always the result of
trauma (a blow) to the rib cage
Signs and Symptoms
leaning toward the injured side
if the rib has punctured a lung, air can escape into the
tissues of the chest wall creating a crackling
sensation (- Subcutaneous Emphysema)
unwillingness to take a deep breath
complaining of local pain and tenderness
pain when moving the rib cage when breathing or
coughing

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Rib Fracture
Treatment
Give oxygen
Make the patient as comfortable as possible
Activate EMS and treat as Load and Go
Transport patient
in the position of maximum comfort on the injured
side

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Flail Chest
Several adjacent ribs fractured in more than one
place can produce a loose section of the chest
wall
The flail section moves inward when the patient
breathes in, and outward when the patient
breathes out
This phenomenon is known as paradoxical
movement

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Flail Chest
Signs and symptoms
shortness of breath
swelling over the injury site
shock
muscle splinting of the injury site
severe pain on inhalation/exhalation
possible paradoxical movement

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Flail Chest
Treatment
Give oxygen as soon as possible
Be prepared to give AR
Help the patient get in a comfortable position and
transport to medical aid.
Activate EMS and treat as Load and Go
Continue to monitor vital signs
Unless there is substantial bleeding, do not apply
bulky padding or dressings

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Use of Dressings on a Flail Chest
Only consider taped-on pad as a treatment in the
following cases:
if there is likely to be a prolonged time before evacuation and
access to medical care
if the patient has fatigued their chest muscles
To apply dressings
Press the segment inward with your gloved hand to stabilize it
Splint in the inward position with a pillow, large bulky dressing, or
folded blanket or parka
Secure this thoroughly in place with tape
Be prepared to help breathing with AR
Do not hold in place with bandages encircling the chest. This
would further impair the patient’s breathing effort

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Pneumothorax
Is a condition that results from air entering the
interpleural space. The air in the interpleural
space compresses the lung and prevents normal
breathing.
There are two types of pneumothorax:
Tension pneumothorax
Spontaneous pneumothorax

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Pneumothorax
Signs and symptoms
reduction of normal respiratory movements on the
affected side
a fall in blood pressure
weak and rapid pulse
a sudden sharp chest pain

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Pneumothorax
Treatment for Tension Pneumothorax
Give oxygen
Activate EMS and treat as Load and Go
Continue to monitor vital signs
Treatment for Spontaneous Pneumothorax
Give oxygen
Transport to medical aid
The patient may prefer to be transported sitting up.

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Open Chest Injuries
In penetration injuries of the chest wall, air can
enter the interpleural space from the outside,
causing the lung to collapse
Air moving back and forth through the chest wall
results in what is often called a sucking chest
wound, because of the sucking sound during
inhalation

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Open Chest Injuries
Signs and symptoms
increasing difficulty in breathing
frothy blood at the mouth/site of wound
rapid, weak pulse
cyanosis
falling blood pressure
localized chest pain

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Open Chest Injuries
Treatment
Seal the wound with any airtight material
Tape the material in place on three sides. Leave the bottom
(based on patient position) side unsealed to release
accumulated air
Continually monitor the “dressing” to ensure that the seal is
effective on inspiration only
Transport the patient
in a position of comfort
in a position which will not impair breathing
give oxygen
monitor vital signs
activate EMS and treat as Load and Go

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Impaled Objects
Impaled objects are things such as broken glass
or large splinters that are both embedded into
and protruding from the body
Signs and Symptoms
Impaled objects are easily identified by sight

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Impaled Objects
Treatment
do not move or remove the object
build up a dressing around the object to hold it in place during
transportation
tape the dressing in place
Transport the patient
in the most comfortable position possible
monitor respiration transport to medical aid immediately.
activate EMS and treat as Load and Go
continue to monitor vital signs
If the object is obviously dangling from the skin or will
cause extreme further damage, it should be removed