Chest Injuries CERT Presentation: Chest Injuries Time Line: 20 minutes Participant manual page reference for slide: n/a The following WSIB learning objectives have been met in this chapter: Chest Injuries - Elective Module 11.1.1. List three types of chest injuries: Penetrating chest wound Fractures of the rib cage Blast injury 11.1.2. Describe three serious effects of chest injuries. 11.2 Recognize a penetrating chest wound. 11.2.1. Describe the signs and symptoms of a penetrating chest wound. 11.3. Describe first aid for a penetrating chest wound. 11.3.1. Describe the aim of first aid for a penetrating chest wound. Chest Injuries 1

Instructor Notes Continued 11.3.2. Describe the types of materials used to seal a penetrating chest wound. 11.3.3. Describe the first aid for a penetrating chest wound using plastic wrap and tape. 11.3.4. Describe the signs and symptoms of a developing tension pneumothorax and describe the first aid. 11.3.5. Describe the reason for immediate medical aid when a tension pneumothorax is suspected. 11.4. Recognize a flail chest. 11.4.1. Define the term flail chest. 11.4.2. List the signs and symptoms of a flail chest. 11.5. Provide first aid for a flail chest. 11.5.1. Describe the aim of first aid for a flail chest. 11.5.2. Describe the first aid for a flail chest. 11.6. Recognize a rib fracture and provide first aid. 11.6.1. List the signs and symptoms of closed fractures of the rib cage. 11.6.2. State the first aid for a closed rib fracture. 11.7. Recognize a blast injury to the chest and provide first aid. 11.7.1. Describe how blast injuries to the chest and the internal organs may be recognized: Mechanisms of injury/History Signs. Symptoms. 11.7.2. Describe the first aid for blast injuries to the chest and its contents. Chest Injuries

Chest Injuries There are three types of chest injuries: Penetrating chest wound Fractures of the rib cage Blast injury Presentation: Chest Injuries Time Line: 20 minutes Participant manual page reference for slide: 143 WSIB requirements: 11.1.1. List three types of chest injuries: Penetrating chest wound Fractures of the rib cage Blast injury 11.1.2. Describe three serious effects of chest injuries Instructor Notes Chest injuries should be considered serious due to the damage that may occur to vital organs in the torso area. Depending on how the chest injury occurred, there may be damage to the lungs, stomach, intestine, and possibly the heart. Chest Injuries

Penetrating Chest Wound ESM. Identify wound and cover wound. Place casualty in position that makes breathing easiest. Seal the wound with a non porous material. Ensure that the valve flutters open when the casualty exhales and seals when casualty inhales. Presentation: Chest Injuries Time Line: 20 minutes Participant manual page reference for slide: 143 WSIB requirements: 11.2 Recognize a penetrating chest wound. 11.2.1. Describe the signs and symptoms of a penetrating chest wound. 11.3. Describe first aid for a penetrating chest wound. 11.3.1. Describe the aim of first aid for a penetrating chest wound. 11.3.2. Describe the types of materials used to seal a penetrating chest wound. 11.3.3. Describe the first aid for a penetrating chest wound using plastic wrap and tape. 11.3.4. Describe the signs and symptoms of a developing tension pneumothorax and describe the first aid. 11.3.5. Describe the reason for immediate medical aid if a tension pneumothorax is suspected. Chest Injuries 4

Instructor Notes - Mandatory Demonstration Bandage a Pneumothorax Always begin with the steps of ESM – For a life threatening breathing emergency, 911/EMS should be called. If you are alone with the casualty's treat them before leaving to make the call. As soon as you identify that there is a penetrating chest wound, it should be covered. You can use the casualty’s hand; a bystander’s gloved hand or your own gloved hand. Place casualty in a position that makes breathing easiest. This is usually semi-sitting, and leaning toward the injured side. This allows the unaffected side to do most of the work. Seal the wound. Stop the air from entering the chest by sealing the area with a non-porous material, such as a large piece of plastic. If there is an embedded object, dressing should be taped around the object and try to make a flutter type valve. Secure the plastic on three sides with tape. Leave the bottom side open to allow air to exit and allow for drainage. Ensure that the plastic is large enough to cover at least three to four inches past the injury. Ensure that the valve flutters open when the casualty exhales and seals when casualty inhales. Watch that this valve continues to function correctly. If it does not, remove and reapply. Tension Pneumothorax If after bandaging the pneumothorax and breathing becomes more difficult for the casualty, a tension pneumothorax may be developing. To fix this, unseal the wound for a few seconds (air may rush out). Then re-bandage, ensuring that when the casualty breathes in that the wound seals. Chest Injuries

Fractured Ribs Signs and Symptoms: A casualty who has a fractured rib may experience pain on deep inspiration or coughing. Pain may also be worsened by activities where the trunk of the body must turn side to side. Shortness of breath. First Aid Treatment: Seek medical attention. Presentation: Chest Injuries Time Line: 20 minutes Participant manual page reference for slide: 143 WSIB requirements: 11.6. Recognize a rib fracture and provide first aid. 11.6.1. List the signs and symptoms of closed fractures of the rib cage. 11.6.2. State the first aid for a closed rib fracture. Instructor Notes Mandatory Demonstration: Bandage and Support Fractured Ribs Isolated rib fractures are generally uncomplicated and non-life threatening. A casualty who has a fractured rib may experience pain on deep inspiration or coughing. Pain may also be worsened by activities where the trunk of the body must turn side to side. Activity should be avoided and the casualty should rest in order to heal the injury. Some mild shortness of breath may occur. Always seek medical attention if a rib fracture is suspected, especially when in the presence of shortness of breath, as it may be more complicated than it may initially seem. Chest Injuries 6

Flail Chest ESM. 911/EMS. This is a major injury and the casualty should be instructed not to move. Steady and support the head and neck. Continue to monitor airway, breathing and circulation. Expose and examine the injured area. Steadying and supporting injured area with hand may offer some relief. Presentation: Chest Injuries Time Line: 20 minutes Participant manual page reference for slide: 143 WSIB requirements: 11.4. Recognize a flail chest. 11.4.1. Define the term flail chest. 11.4.2. List the signs and symptoms of a flail chest. 11.5. Provide first aid for a flail chest. 11.5.1. Describe the aim of first aid for a flail chest. 11.5.2. Describe the first aid for a flail chest. Instructor Notes Mandatory Demonstration: Bandage and Support a Flail Chest A flail chest is when three or more ribs have broken in two or more places, causing a section of the rib cage to be detached from the rest of it. This area, on inspiration will move inward, instead of outward with the rest of the rib cage due to the negative pressure in the chest. This is called paradoxical movement. Chest Injuries 7

Instructor Notes Continued The casualty is instructed not to move and to be kept in the position found, if possible. A pneumothorax is often associated with a flail chest, and is the main cause of severe shortness of breath and high mortality. Signs and Symptoms of a Flail Chest Shortness of breath Severe anxiety Pain All signs and symptoms of shock Treatment of a Flail Chest ESM. For a life threatening breathing emergency 911/EMS should be called as soon as possible. A flail chest is a major injury and the casualty should be instructed not to move. Steady and support the head and neck. Continue to monitor airway, breathing and circulation. Expose and examine the injured area. If the casualty is having difficulty with breathing, you may support the injured area with your hand. This may offer some relief. Provide ongoing care. Chest Injuries

Blast Injuries Impaled objects thrown by the explosion. Being thrown by the explosion. Hollow organs may be affected by the shockwave of the explosion (i.e. lungs). Presentation: Chest Injuries Time Line: 20 minutes Participant manual page reference for slide: 145 WSIB requirements: 11.7.1. Describe how blast injuries to the chest and its internal organs may be recognized: Mechanisms of injury/history. Signs Symptoms Instructor Notes Blast injuries may result from direct or indirect exposure to an explosion. This source of the explosion may vary. It may be from a planned detonation gone wrong or an accidental explosion from gas build up in a confined space. Either way the injuries the casualty may sustain can vary from: Impaled objects thrown by the explosion. Being thrown by the explosion. Hollow organs may be affected by the shockwave of the explosion (i.e. lungs). Chest Injuries

Blast Injuries First Aid ESM. Steady and support the head and neck (if you suspect a spinal injury). If you do not suspect a spinal injury, the casualty should semi sit. Continue to monitor airway, breathing and circulation. Expose, examine and treat any injured areas that you are able to. Provide ongoing care. Presentation: Chest Injuries Time Line: 20 minutes Participant manual page reference for slide: 143 WSIB requirements: 11.7. Recognize a blast injury to the chest and provide first aid. 11.7.2. Describe the first aid for blast injuries to the chest and its’ contents. Instructor Notes- Treatment of Blast Injuries Always begin with ESM. For a life-threatening breathing emergency, 911/EMS should be called as soon as possible. If you suspect a spinal injury, the casualty should be instructed not to move. Steady and support the head and neck (if you suspect a spinal injury). If you do not suspect a spinal injury, the casualty should semi-sit. Continue to monitor airway, breathing and circulation. Expose, examine and treat any injured areas. Provide ongoing care. Chest Injuries