Lesson 6: Chest Injuries

Objectives Demonstrate a field assessment of a person with a chest injury Describe the emergency treatment and long term care of Fractured rib/clavicle Pneumothorax Tension pneumothorax Fail Chest Sucking Chest Wound Describe when to evacuate SLOW vs FAST

Checking and Caring for Chest Injuries Signs and Symptoms Deformity, open wounds, tenderness, swelling (DOTS) Windpipe pushed to one side of neck Abnormal breathing Bleeding or holes with/without bubbles, bruising Unusual noises like gurgling Abnormal chest rise

Checking and Caring for Chest Injuries Signs and Symptoms (cont’d) Patient is guarding a particular area While exerting some pressure with hands you Hear cracking sounds Feel/hear crumbling Find depressions Patient has point pain/tenderness along ribs/clavicle

Chest Injuries

Chest Injuries

Rib Injuries Signs and Symptoms Pain in the clavicle or rib area Complaints of increased pain with deep breath Discoloration, bruising or swelling Guarding the injury from being touched/moved Specific point where pain is most intense

Rib Injury Treatment Protect simple fracture by Supporting arm on injured side with sling and swath DO NOT band snugly around patients chest Encourage patient to take regular deep breaths to keep lungs clear of fluid Try padding area to increase comfort

Rib Injury Care

Lung Injuries Lung injuries can lead to pneumothorax (air trapped in chest). Leads to Difficulty breathing Rising anxiety Pneumothorax can worsen until patient cannot breath adequately (tension pneumothorax ) Suspicion of pneumothorax requires immediate (FAST) evacuation No treatment avail in Wilderness setting for a lung injury

Flail Chest Ribs broken in several places, free floating bones Flail section moves in opposition to rest of chest Not common but can be life-threatening, immediate evacuation May need to give rescue breaths Applying bulky dressing may allow patient to breath easier. Do not wrap chest with tape

Sucking Chest Wound Characterized by open wound that bubbles and makes noises when breathing Do not remove impaled objects. Immobilize and seal wound Apply Occlusive dressing Air barrier just as plastic bag One corner is left open to allow air to escape

Guidelines for Evacuation GO SLOW with suspected rib fracture. Patient may walk Must be evaluated by health care provider Patient may have difficulty breathing GO FAST and transport patient for: Increase difficulty breathing Flail chest sucking chest wound Transport on side with injury or other position of comfort.

Preventing Chest Injuries Prevention important since no effective field treatment available Possible causes of chest injuries in Wilderness? Methods for avoiding these causes?