Chapter 14 Chest, Abdomen and Pelvic Injuries Hannah Benjamin and Ayla Cole

Vocabulary  Chest- Upper part of the torso that contains the heart, lungs and major blood vessels.  Abdomen- The middle section of the torso that contains the stomach, liver, spleen and intestines.  Pelvis- Lower part of the torso that contains the bladder, internal reproductive organs and the intestines.  Rib cage- Cage of bones made up of 12 pairs of ribs, the sternum and the spine.  Sternum (Breastbone)- Long, flat bone in the middle of the front of the rib cage.  Genitals- External reproductive organs.

Chest Injuries  The second leading cause of trauma deaths each year in the United States.  35% of motor- vehicle collision deaths are caused by fatal chest injuries.  Open chest wounds- When an object (Ex: knife, bullet, etc.) penetrates the chest.  Closed chest wounds- Caused by blunt objects, skin is not broken.

Signals of Chest Injuries  Trouble breathing  No breathing  Severe pain at the site of the injury  Flushed, pale or bluish skin  Obvious deformity caused by the injury  Coughing up blood  Bruising from a blunt injury  A ‘sucking’ or other sound made when person breathes.

Care for Chest Injuries  Call or the local emergency number.  Limit the movement of the victim.  Monitor the victim’s breathing and signs of life.  Control any bleeding  Take steps to limit shock.

Rib Fractures  Caused by a direct force to the chest.  Non life threatening injury  Victim’s breathing is shallow, because normal breathing is difficult and painful for them.  Rib fractures are less common in children because their ribs are flexible, so they bend instead of breaking.  But the forces that cause rib fractures in adults can be life threatening in children because the injury can cause the lung tissue to bruise and trouble breathing.

Care for Rib Fractures  Have the victim rest in a position that makes it easier from them to breathe. Encourage the person to take slow, deep breathes.  Call or local emergency number.  Give the victim a blanket or a pillow to hold against the fractured rib.  Use a sling, binder or pillow and hold the person’s arm against the fractured ribs.  Monitor breathing and take steps to minimize shock.

Puncture Wounds  Wounds can be minor or life threatening and can be internal or external bleeding.  Stab and gunshot wounds are examples of puncture wounds.  Sucking chest wound- When an object penetrates the ribcage and air is passing out of the chest cavity making a “sucking” sound.

Care for Puncture Wounds  Call  Cover the wound with large occlusive dressing,piece of plastic wrap, or folded cloth.  Tape dressing in place except for one corner that stays loose.  Monitor the victim’s breathing.  Take steps to minimize shock.

Abdominal Injuries  Area under chest and above pelvis  Easily injured due to lack of bones  Protects the intestines, stomach, liver, spleen and other vital organs.  Stomach can bleed badly when injured and food that’s digesting can leak into the abdominal cavity causing an infection.

Signals of Abdominal Injuries  Severe pain  Bruising  External bleeding  Nausea and vomiting  Pain, tenderness, tight or rigid feeling in the abdomen  Organs spilling out  Signs of shock

Open Abdominal Injuries  Call 911  Use disposable gloves or some barrier  Do not use direct pressure, or very gentle pressure to control bleeding  Don’t push the organs back in!  Remove clothing from wound– if it’s stuck to the organs cut around it  Use moist, sterile or clean dressing loosely over the wound  Cover dressing with plastic wrap if it’s available  Cover dressing with towel to maintain temperature

Closed Abdominal Injuries  Place person on back with knees bent if its comfortable– allow the abdominal muscles to relax  Avoid direct pressure on area  Place blankets under knees if possible

Pelvic Injuries  Lower part of the trunk.  Pelvic bone is hard to break.  Hold bladder and internal reproductive organs.  The femoral arteries, major arteries, and nerves pass through the pelvic area.  Injuries sometimes involve the genitals.  Can be open or closed wounds.

Signals of Pelvic or Genital Injuries  Severe pain  Bruising  External bleeding  Nausea and vomiting (sometimes contains blood).  Weakness  Thirst  Pain, tenderness or a tight feeling in the area.  Organs protruding from the injury  Rigid abdominal muscles  Shock

Care for Pelvic Injuries  Don’t move person– try to keep them lying flat  If there is a genital injury…  For males:  Soft, sterile dressing and cold compress  Don’t remove impaled objects  Apply direct pressure to control any bleeding  Use a barrier, or have them give themselves care if you feel uncomfortable  For females:  Basically the same except make sure not to put anything in the vagina

Other Things to Remember  Could be a crime scene  Clear the area, and put a blanket over the person  If working with a minor, explain what care needs to be done and walk them through it if they don’t want your help. If the parents are around you should get their consent and get them to help.  If person is of opposite sex, you can enlist a same-sex bystander for help.

Scenario  The world has gone into chaos because of the recent zombie apocalypse. You are with your survival group on a supply run in an supposedly abandoned small town. Suddenly, a horde of hungry zombies appear out of nowhere and you start running for your life. Unfortunately, your friend in the group doesn’t have great balance skills and she falls into a sharp wooden fence post that badly cuts into her abdominal area. You manage to get your friend to safety in an abandoned building but you won’t be safe for long with many hungry zombies so close. You notice your friend's wound is bleeding severely and that some organs are starting to spill out. Your time is limited and your friend’s condition is starting to get worse. What do you do?

Video 

Review  What kind of dressing do you use for a pelvic injury?  What are two signs of an abdominal injury?  How do you treat a closed abdominal injury?  Are rib fractures a life threatening or non life threatening injury?  What kind of objects are closed chest wounds caused by?