Chest Injuries

1
Chapter 22

• Chest Injuries

2
Objectives

• 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.

3
The Chest
4
Organs of the Chest
5
Injuries to the Chest

• Open chest injuries
• Caused by penetrating trauma
• Closed chest injuries
• Caused by blunt trauma

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
Assessment of Chest Injuries

• DCAP-BTLS
• Chest wall movement
• Paradoxical movement
• Hemoptysis
• Shock
• Cyanosis

8
Complications of 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
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
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
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
Signs and Symptoms of Tension Pneumothorax

• Respiratory distress
• Distended neck veins
• Tracheal deviation
• Tachycardia
• Low blood glucose level
• Decreased lung sounds

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
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
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
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
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
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
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
Blunt Myocardial Injury

• Bruising of heart muscle
• Pulse is often irregular.
• There is no prehospital treatment for this
  condition.
• Check patients pulse and note irregularities.
• Provide supplemental oxygen and arrange for
  immediate transport.

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
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.