Ch. 9-Injuries to the Chest, Abdomen, and Genitalia 1

9.1 Chest Injuries Blunt trauma (caused by a forceful blow to the chest) Penetrating injury (an object penetrates the chest wall) Compression injury (the chest cavity is compressed rapidly, usually during an automobile accident) 2

General Signs and Symptoms of Chest Injury Pale, cool, clammy skin Cyanosis (bluish coloring of the fingernails, fingertips, lips, or skin) Dyspnea (shortness of breath or difficulty breathing) Rapid breathing (more than 20 breaths per minute) Tracheal deviation Pain during breathing Distended neck veins Pain at the injury site, or pain near an injury that is made worse by breathing Coughing up of blood (hemoptysis), usually bright red and frothy Failure of the chest to expand normally during inhalation Shock Rapid, weak pulse (more than 100 beats per minute) Open wounds to the chest Bruising or deformity to chest wall Changing mental status, including confusion, agitation, restlessness or irrational behavior 3

Vocabulary Dyspnea- Shortness of breath or difficulty in breathing Tracheal deviation- Displacement of the trachea to one side or the other Hemoptysis- Coughing up of blood Flail chest- Instability of a section of chest wall Paradoxical movement- A condition in which the injured area of the chest moves opposite the rest of the chest during breathing 4

General First Aid Care Principles for Chest Injuries Activate the EMS system immediately; then follow these steps: 1. Your first priority is to open the airway if necessary; ensure adequate ventilation. 2. Place an occlusive dressing over any open wounds to the chest; control external bleeding. 3. Never try to remove an impaled object; stabilize it to prevent movement until the victim can receive medical help. 4. If there is an object impaled in the chest: • Cut away clothing to expose the wound. • Dress the wound around the impaled object to control bleeding and control a sucking chest wound. • Stabilize the impaled object with rolls of self-adhering bandages or bulky dressings. • Tape bandages in place to stabilize the impaled object. 5

PROGRESS CHECK 1. One of the two most important signs of chest injury is a change in ____________. (skin color/normal breathing pattern) 2. One of the two most important signs of chest injury is the ____________ rate. (respiratory/heart) 3. The first priority in caring for a victim of chest injury is to ____________. (control bleeding/ensure adequate ventilation/prevent further injury) 4. You should ____________ an impaled object in the chest. (remove/stabilize, then remove/immobilize and leave in place) 6

9.2 Specific Chest Injuries Flail Chest Immediately activate the EMS system; then: 1. Maintain an open airway and administer artificial ventilation if the breathing is inadequate. 2. Use gentle palpation to locate the edges of the flail section; stabilize with a pad of dressings or a pillow. Secure with wide tape. 3. Position the victim with the flail segment against an external support in a semi-sitting position or lying in a supine position with the segment splinted with the arm. 7

Compression Injuries and Traumatic Asphyxia Signs and symptoms include: Pale, cool, clammy skin Weak pulses Increased heart rate Increased breathing rate Distended neck veins Bloodshot, protruding eyes Cyanotic tongue and lips Coughing or vomiting blood First Aid Care Activate the EMS system immediately, then: 1. Maintain an open airway and administer artificial ventilation if breathing is inadequate. 2. Control any bleeding that results from the trauma. 3. Monitor the victim closely; position the victim in a supine position. 8

Broken Ribs Signs and symptoms include: First Aid Care Severe pain at the fracture site Grating sound upon palpation (crepitus) Chest deformity Shallow, rapid breathing Bruising or lacerations at the suspected fracture site Frothy blood at the nose or mouth (indicating lung laceration) First Aid Care Activate the EMS system immediately, then: 1. Use a sling and swathe to utilize the victim’s arm as a splint and support the forearm of the injured side positioned across the chest 2. Position the victim in a supine position. 3. Monitor the victim’s ABCDs, watching for signs of internal bleeding that could lead to shock. 9

Vocabulary Traumatic asphyxia- Sudden compression of the chest wall that forces blood to flow the wrong way. Crepitus- A sandpaperlike grating sound made by the ends of a broken bone as they rub together Hemothorax- An accumulation of blood in the chest cavity Tension pneumothorax- A situation in which air enters the pleural space through a oneway defect in the lung, resulting in a progressive increase in pressure in the pleural cavity that causes the lung to collapse and that impairs circulation Pneumothorax- A condition in which air from a lung or from the outside fills the chest cavity, but does not fill the lung. 10

PROGRESS CHECK 1. In flail chest, the chest wall ____________ when the victim exhales. (collapses/moves/protrudes) 2. Flail chest most often occurs when multiple ____________ are fractured. (bones/ribs/joints) 3. To check for flail chest, have the victim lie on his or her back and check for ________ as the victim breathes. (crepitus/pain/paradoxical motion) 4. Traumatic asphyxia occurs from sudden ____________ of the chest wall. (compression/collapse/penetration) 5. The most common symptom of rib fracture is ____________. (deformity/pain/bruising) 6. The greatest priority in treating rib fracture is to splint the chest so the victim ____________. (can breathe adequately/is not in pain/will not be further injured by broken bone ends) 7. In treating a rib fracture, you should use ____________. (tape/continuous strapping/a sling and swathe) 8. In a hemothorax, ____________ enters the chest cavity. (air/blood/pressure) 9. To help prevent tension pneumothorax, you should always leave one corner of a chest bandage ____________. (over the wound/untaped/ at least 2 inches beyond the wound) 11

9.3 Abdominal Injuries To assess a victim for abdominal injury: 1. Have the victim lie supine with knees flexed and supported; remove or loosen clothing over the abdomen. 2. Inspect for lacerations, open wounds, bruising, impaled objects, or protruding abdominal organs. 3. Gently palpate all four quadrants for guarding, rigidity, pain, and tenderness. 12

13

Signs and Symptoms of Abdominal Injuries Distended or irregularly shaped abdomen Bruising of the abdomen flank or back Tenderness (pain on palpitation) Pain, ranging from mild discomfort to intense, intolerable pain Pain other than at the injury site Pain radiating to either shoulder “Guarding” (voluntary contraction of the abdominal muscles) Fetal position or lying with legs drawn up toward the chest and abdomen Weak peripheral pulses Abdominal cramping A rigid, boardlike, stiff or hard abdomen on palpation Nausea and/or vomiting; the victim may vomit blood Rapid, shallow breathing Rapid pulse Open wounds and penetrations Organs protruding through open wounds Blood in the urine Extreme weakness Thirst Low blood pressure 14

General First Aid Care 1. Take measures to prevent shock; keep the victim warm, but do not overheat. 2. Control bleeding and dress all open wounds with a dry, sterile dressing. 3. If any object has penetrated or impaled the victim • Cut clothing away from the object. • Dress the wounds around the object to control bleeding. • Stabilize the object with bulky dressings. • Bandage the object in place to prevent movement. 4. Position the victim for greatest comfort; victims may want to lie on the back with the knees flexed. If possible, elevate the feet. 5. Be alert for vomiting; position the victim for adequate drainage. Constantly monitor vital signs and abdominal condition. 6. Do not give the victim anything by mouth. 15

Abdominal Evisceration Activate the EMS system, then: 1. Cover protruding abdominal organs with a clean dressing moistened with sterile water if possible or clear water that is clean enough to drink. 2. Cover the moist dressing with an occlusive material, such as clean plastic wrap, to retain moisture and warmth. 3. Prevent shock, and constantly monitor the victim’s vital signs. Never touch abdominal organs or try to replace them in the abdominal cavity. 16

Rupture or Hernia Signs and symptoms include: Sharp, stinging pain Feeling of something giving way at the site of the rupture Swelling Possible nausea and vomiting First Aid Care Activate the EMS system immediately, then: 1. Position the victim on his or her back with the knees well drawn up, and place a blanket or other padding under the knees. 2. Cover the victim with a blanket to preserve body warmth. Never try to force a protrusion back into the abdominal cavity. 17

Vocabulary Evisceration- The protrusion of abdominal contents through a laceration or other wound Hernia- Protrusion of an internal organ through the abdominal wall or into another body cavity 18

PROGRESS CHECK 1. The amount of ____________ does not necessarily indicate how serious abdominal injury is. (pain/external blood/deformity) 2. Most abdominal injury victims are most comfortable on their back with the ____________. (feet elevated/head elevated/knees drawn up) 3. If abdominal organs protrude through a wound, you should ____________ them. (cover/replace/remove) 19

9.4 Injuries to the Genitalia Male Genitalia 1. Wrap the penis or scrotum in a soft, sterile dressing moistened with sterile or clean water. 2. If there is a penetrating or impaled object, do not remove it 3. If part of the penis or scrotum is caught in a zipper, cut off the zipper fastener and separate the teeth 4. Apply an ice bag or cold compresses to relieve pain and reduce swelling. 5. If there are avulsed parts, wrap in sterile gauze moistened with clean water and send them with the victim. Female Genitalia 1. Control bleeding with direct pressure. 2. Dress the wounds, keeping the dressing in place with a diaper-type bandage. Stabilize any impaled objects or foreign bodies. 3. Use ice packs or cold compresses to relieve pain and reduce swelling. 20

PROGRESS CHECK 1. In both male and female victims with injuries to the genitalia, apply ____________ to relieve pain and reduce swelling. (direct pressure/an ice bag/sterile gauze) 2. Always try to ____________ avulsed skin. (preserve/finish detaching/clean) 3. If a woman was the victim of sexual assault, try to ____________. (comfort her/find the assailant/preserve the chain of evidence) 21