1. Chest Injuries Basic
Upon completion of this session the student will be able to:
Describe the general signs of chest injury.
Outline the signs, symptoms and demonstrate specific treatments of:
Rib fracture
Flail chest
Pneumothorax, both Spontaneous and Tension
Open chest injuries and
Impaled objects

2. Anatomy
The chest is formed by the ribcage and the enclosed organs, primarily the lungs.
Ribs are flat bones attached to the spinal column. They form a cavity, or cage, to protect the heart and lungs.
Every rib is attached to the spinal column at the thoracic vertebrae.
The highest seven pairs of ribs are attached to the sternum by cartilage, known as the costochondal junction.
The next three pairs of ribs are joined by a common cartilage attached to the seventh rib cartilage, which is in turn attached to the base of the sternum.
The lowest two pairs of ribs are floating ribs. They are the shortest ribs and have no attachment to the sternum.
The sternum - breast bone - forms the middle part of the front of the rib cage. The xiphoid process forms the inferior end of the sternum.

3. 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
Injuries to the chest can be life-threatening.
These injuries may result in damage to either the heart or the lung and can cause severe internal bleeding.
Rib cage fractures may result in serious injury to vital organs.
Chest injuries are divided into two groups:
Closed chest injuries; and
Open chest injuries
Deep, open wounds allow air to enter the chest cavity; closed wounds usually involve injury to the ribs and possibly underlying structures.

4. 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
Look for the following signs beyond an obvious chest wound:
• impaired breathing,
• irregular, or lack of, chest expansion,
• coughing-up of blood,
• shock,
• subcutaneous emphysema.
Of 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.