1. Chapter 22 Chest Injuries

2. Chapter 22: Chest Injuries 2 Differentiate between a pneumothorax, a hemothorax, a tension pneumothorax, and a sucking chest wound. Describe the emergency medical care of a patient with a flail chest. Describe the emergency medical care of a patient with a sucking chest wound. Demonstrate the steps in the emergency medical care of a sucking chest wound. Objectives

3. Chapter 22: Chest Injuries 3 The Chest

4. Chapter 22: Chest Injuries 4 Organs of the Chest

5. Chapter 22: Chest Injuries 5 Injuries to the Chest Open chest injuries –Caused by penetrating trauma Closed chest injuries –Caused by blunt trauma

6. Chapter 22: Chest Injuries 6 Signs and Symptoms of Chest Injuries Pain at the site of injury Pain aggravated by increased breathing Dyspnea Hemoptysis Failure of the chest to expand normally Rapid, weak pulse and low blood pressure Cyanosis around the lips or fingernails

7. Chapter 22: Chest Injuries 7 Assessment of Chest Injuries DCAP-BTLS Chest wall movement Paradoxical movement Hemoptysis Shock Cyanosis

8. Chapter 22: Chest Injuries 8 Complications of Chest Injuries

9. Chapter 22: Chest Injuries 9 Pneumothorax Air accumulates in the pleural space. Air enters through a hole in the chest wall. –The lung may collapse in a few seconds or a few minutes. An open or penetrating wound to the chest is called a sucking chest wound.

10. Chapter 22: Chest Injuries 10 Caring for Open Pneumothorax Clear and manage the airway. Provide oxygen. Seal an open wound with an occlusive dressing. Depending on local protocol, tape down all four sides or create a flutter valve.

11. Chapter 22: Chest Injuries 11 Spontaneous Pneumothorax Some people are born with or develop weak areas on the surface of the lungs. Occasionally, the area will rupture spontaneously, allowing air into the pleural space. Patient experiences sudden chest pain and trouble breathing. Consider a spontaneous pneumothorax in a patient with chest pain without cause.

12. Chapter 22: Chest Injuries 12 Tension Pneumothorax Can occur from sealing all four sides of the dressing on a sucking chest wound. Can also occur from a fractured rib puncturing the lung or bronchus. Can also result from a spontaneous pneumothorax.

13. Chapter 22: Chest Injuries 13 Signs and Symptoms of Tension Pneumothorax Respiratory distress Distended neck veins Tracheal deviation Tachycardia Low blood glucose level Decreased lung sounds

14. Chapter 22: Chest Injuries 14 Caring for Tension Pneumothorax If a tension pneumothorax develops from sealing an open chest wound, partly remove the dressing to let the air escape. If there is no open wound, follow local protocol.

15. Chapter 22: Chest Injuries 15 Hemothorax Collection of blood in the pleural space Suspect if the following are seen: –Signs and symptoms of shock –Decreased breath sounds on affected side If both air and blood are present in the pleural space, it is a hemopneumothorax.

16. Chapter 22: Chest Injuries 16 Rib Fractures They are very common in the elderly. A fractured rib may lacerate the surface of the lung. Patients will avoid taking deep breaths and breathing will be rapid and shallow. –The patient often holds the affected side to minimize discomfort. –Administer oxygen.

17. Chapter 22: Chest Injuries 17 Flail Chest (1 of 2) Three or more ribs fractured in two or more places Or when the sternum is fractured along with several ribs. A segment of the chest wall may be detached from the rest of the thoracic cage. Creates paradoxical movement.

18. Chapter 22: Chest Injuries 18 Flail Chest (2 of 2) Breathing is extremely painful and patient rarely receives adequate oxygenation. Care includes: –Maintaining the airway. –Providing respiratory support. –Performing ongoing assessment. –Immobilizing flail segment.

19. Chapter 22: Chest Injuries 19 Pulmonary Contusion Bruising of the lung Develops over hours Alveoli fill with blood, and edema accumulates in the lung, causing hypoxia. Provide oxygen and ventilatory support.

20. Chapter 22: Chest Injuries 20 Traumatic Asphyxia Sudden, severe compression of chest Produces rapid increase in pressure within chest Results in neck vein distention, cyanosis, and bleeding into the eyes Provide supplemental oxygen and monitor vital signs. Arrange for immediate transport.

21. Chapter 22: Chest Injuries 21 Blunt Myocardial Injury Bruising of heart muscle Pulse is often irregular. There is no prehospital treatment for this condition. Check patient’s pulse and note irregularities. Provide supplemental oxygen and arrange for immediate transport.

22. Chapter 22: Chest Injuries 22 Pericardial Tamponade Blood or other fluids collect in the pericardium. Signs and symptoms include: –Very soft and faint heart tones –Weak pulse –Low blood pressure –Decrease in difference between systolic and diastolic blood pressure –Jugular vein distention (JVD) Provide oxygen and arrange for prompt transport.

23. Chapter 22: Chest Injuries 23 Laceration of the Great Vessels The superior vena cava, inferior vena cava, pulmonary arteries and veins, and aorta are contained in the chest. Injury to these vessels can cause fatal hemorrhaging. Treatment includes: –CPR –Ventilatory support –Supplemental oxygen –Arranging for immediate transport.