CHAPTER # 19 INJURIES TO THE CHEST

1. CHAPTER # 19 INJURIES TO THE CHEST

2. Chest Injuries - The 2nd leading cause of death from trauma 1/3 of all auto deaths involve chest trauma 2 Categories of chest injuries 1. Open - object passes through the chest wall   2. Closed- skin of the chest is not broken

3. Main Types of Injury 1. Blunt Trauma 2. Penetrating Injury 3. Compression Injury

4. General Signs and Symptoms        Shortness of breath ·        Pain during breathing ·        lack of chest expansion ·        Cyanosis ·        Coughing up blood ·        Distended neck veins ·        Rapid weak pulse ·        Falling blood pressure ·        Bruising or obvious fractures ·        Shock ·        Subcutaneous Emphysema

5. 2 Key Signs ----------- • Respiratory rate 12-20 times per minute (normal) • 2. Change in normal breathing patterns

6. GENERAL TREATMENT FOR CHEST INJURIES 1.      A B C’s 2.      Control external bleeding 3.      Allow the patient to get into a position of comfort 4.      Monitor vital signs

7. TRAUMATIC ASPHYXIA Sudden compression of the chest wall, blood is forced out the wrong side of the heart and into the veins SIGNS AND SYMPTOMS ·Shock ·Distended neck veins ·Bloodshot protruding eyes ·Cyanotic tongue and lips ·Hemoptysis (coughing up blood)

8. CARE 1.      Open the Airway 2.      High O2 3.      Control Bleeding 4.      Dire emergency - Immediate emergency transport

9.  BROKEN RIBS Uncommon in children Occurs most often in the middle ribs of adults Rib Fracture Complications       Pneumothorax 2.      Hemothorax 3.      Subcutaneous Emphysema 4.      Lacerated intercostal vessels - vessels around ribs 5.      Lung Contusions 6.      Injuries to liver or spleen

10. SIGNS AND SYMPTOMS 1.      Major sign is pain at the fracture site 2.      Increased pain on movement, coughing or deep breathing 3.      Patient will hold his hand over the effected area 4.      Grating sound 5.      Chest deformity 6.      Shallow irregular breathing 7.      Subcutaneous emphysema 8.      Bruising or laceration at the fracture site Frothy blood at the nose or mouth indicating the rib has punctured the lung

11. CARE Make sure the patient can breath adequately use a pillow or a blanket to support fractured ribs. Sling and Swathe the patients arm against the chest and place the patient in a position of comfort.

12. FLAIL CHEST Occurs when- 2 or more ribs are broke in 2 or more places Paradoxical breathing - opposite motion of broken section during breathing  Can be Life threatening - A fractured rib may puncture a lung  Signs and Symptoms ·        Shortness of breath ·        Paradoxical breathing ·        Swelling ·        Shock

13. Patient Care Have patient lie on back A B C’s Tape small pillow or thick dressing to chest       Monitor vital signs

14. HEMOTHORAX TENSION PNEUMOTHORAX PNEUMOTHORAX

15. PNEUMOTHORAX Air enters the chest cavity but not the lung, causing the lung to collapse. Can be caused by a sucking chest wound, a lung laceration or a spontaneous pneumothorax.

16. SPONTANEOUS PNEUMOTHORAX Weak area of lung ruptures - the lung loses it’s ability to expand. Common among smokers or emphysema patients

17. PNEUMOTHORAX SIGNS AND SYMPTOMS ·Sharp, sudden chest pain ·Failure of Lungs to expand ·Decreased or absent breath sounds ·Severe respiratory distress with SOB

18. CARE 1.      Maintain an open airway 2.      High O2 3.      Cover chest wounds, apply an occlusive dressing, overlap wound by 2 inches 4.      Leave 1 corner of the dressing untaped to allow the pressure a release valve

19. HEMOTHORAX Plural space fills with blood, creates pressure on the heart and lungs. The lungs then are unable to expand. The severe bleeding also causes shock Causes-----Blunt or penetrating trauma to the chest Often accompanies a pneumothorax  Can result from lacerated blood vessels in the chest or a lacerated lung

20. SIGNS AND SYMPTOMS ·Shock ·Rapid Heartbeat ·Rapid shallow breathing ·Tightness in the chest ·Weak thready pulse ·Bruising ·Confusion or anxiety ·Hemoptysis (coughing up blood) ·Frothy or bloody sputum

21. CARE 1.      Notify EMS 2.      Place patient in a semi or reclining position (unless C spine) 3.      Administer 02 4.      Control bleeding 5.      Treat for shock

22. TENSION PNEUMOTHORAX Life threatening, air leaks out of lung until the lung is collapsed. Air pressure may compress the major blood vessels, heart or the opposite lung. This prevents the blood from returning to the heart.

23. SIGN AND SYMPTOMS ·Obvious increased difficulty in breathing ·Bulging of chest wall above the clavicle and between the ribs ·Reduced breath signs on 1 side of the chest ·Falling B/P, reduced pulse pressure ·Rapid, weak pulse ·Uneven chest movement ·Cyanosis ·Extreme anxiety ·Bulging of neck veins ·Tracheal deviation

24. TREATMENT 1.      Activate EMS immediately 2.      If it’s a sucking chest wound release the air on expiration 3.      Give O2 if available 4.      Assist ventilation’s as needed 5.      Treat for shock

25. SUBCUTANEOUS EMPHYSEMA The lung or part of the bronchial tube is lacerated. Air escapes into the soft tissues of the chest. Crackling sound may be present under the skin tissue. This is not an injury, it is a sign of serious chest injury, usually the result of a pneumothorax

26. SUCKING CHEST WOUNDS Open chest wound where air enters the wound and causes a pneumothorax

27. CARE 1.Activate EMS 2.Apply an airtight dressing, plastic wrap is not strong enough. You can use a plastic bag, aluminum foil, or Vaseline gauze with a pressure dressing. Overlap wound with dressing by at least 2 inches all the way around. 3.      Give O2 (if available) and be prepared to assist ventilation’s 4.      Position patient for best breathing position if possible

28. Injuries to the Genitalia Treat as you would for any soft tissue injury Cold packs to relieve pain Never remove impaled objects