3 Overview of Chest Injuries Can be life-threateningMay result in damage to either the heart or the lung and cause severe internal bleedingRib cage fractures may result in serious injury to vital organsDeep, open wounds allow air to enter the chest cavityClosed wounds usually involve injury to the ribs and possibly underlying structures
4 Signs of Chest Injuries An obvious chest woundImpaired breathingIrregular – or lack of – chest expansionCoughing-up of bloodShockSubcutaneous emphysema: crackling sensationOf all signs, a change in the normal breathing pattern is the most indicative of chest injury.A patient who has breathing difficulty will usually move in to a position where breathing is easiest. Typically this will be either sitting or reclining.
6 Rib FractureRib fractures are almost always the result of trauma (a blow) to the rib cageSigns and Symptomsleaning toward the injured sideif 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 breathcomplaining of local pain and tendernesspain when moving the rib cage when breathing or coughing
7 Rib Fracture Treatment Transport patient Give oxygen Make the patient as comfortable as possibleActivate EMS and treat as Load and GoTransport patientin the position of maximum comfort on the injured side
8 Flail ChestSeveral adjacent ribs fractured in more than one place can produce a loose section of the chest wallThe flail section moves inward when the patient breathes in, and outward when the patient breathes outThis phenomenon is known as paradoxical movement
9 Flail Chest Signs and symptoms shortness of breath swelling over the injury siteshockmuscle splinting of the injury sitesevere pain on inhalation/exhalationpossible paradoxical movement
10 Flail Chest Treatment Give oxygen as soon as possible Be prepared to give ARHelp the patient get in a comfortable position and transport to medical aid.Activate EMS and treat as Load and GoContinue to monitor vital signsUnless there is substantial bleeding, do not apply bulky padding or dressings
11 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 careif the patient has fatigued their chest musclesTo apply dressingsPress the segment inward with your gloved hand to stabilize itSplint in the inward position with a pillow, large bulky dressing, or folded blanket or parkaSecure this thoroughly in place with tapeBe prepared to help breathing with ARDo not hold in place with bandages encircling the chest. This would further impair the patient’s breathing effortThe tape reduces the mobility of the chest wall and thus limits the already compromised expansion of the lung.
12 PneumothoraxIs 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 pneumothoraxSpontaneous pneumothorax
13 Pneumothorax Signs and symptoms reduction of normal respiratory movements on the affected sidea fall in blood pressureweak and rapid pulsea sudden sharp chest pain
14 Pneumothorax Treatment for Tension Pneumothorax Give oxygenActivate EMS and treat as Load and GoContinue to monitor vital signsTreatment for Spontaneous PneumothoraxTransport to medical aidThe patient may prefer to be transported sitting up.
15 Open Chest InjuriesIn penetration injuries of the chest wall, air can enter the interpleural space from the outside, causing the lung to collapseAir moving back and forth through the chest wall results in what is often called a sucking chest wound, because of the sucking sound during inhalationImportant NotesIf the chest wall is punctured, air can enter the pleural cavity and the patient can develop Pneumothorax (see Pneumothorax, above). If open chest injuries are not treated properly, they can result in tension pneumothorax.
16 Open Chest Injuries Signs and symptoms increasing difficulty in breathingfrothy blood at the mouth/site of woundrapid, weak pulsecyanosisfalling blood pressurelocalized chest pain
17 Open Chest Injuries Treatment Transport the patient Seal the wound with any airtight materialTape the material in place on three sides. Leave the bottom (based on patient position) side unsealed to release accumulated airContinually monitor the “dressing” to ensure that the seal is effective on inspiration onlyTransport the patientin a position of comfortin a position which will not impair breathinggive oxygenmonitor vital signsactivate EMS and treat as Load and Go
18 Impaled ObjectsImpaled objects are things such as broken glass or large splinters that are both embedded into and protruding from the bodySigns and SymptomsImpaled objects are easily identified by sight
19 Impaled Objects Treatment Transport the patient do not move or remove the objectbuild up a dressing around the object to hold it in place during transportationtape the dressing in placeTransport the patientin the most comfortable position possiblemonitor respiration transport to medical aid immediately.activate EMS and treat as Load and Gocontinue to monitor vital signsIf the object is obviously dangling from the skin or will cause extreme further damage, it should be removed