Book Title Edition Chapter 1 Lecture © 2012 Pearson Education, Inc. Chapter 9 Injuries to the Chest, Abdomen, and Genitalia Slide Presentation prepared by Randall Benner, M.Ed., NREMT-P

Learning Objectives Identify the three main types, and general signs and symptoms, of chest injuries. Describe and demonstrate basic first aid care for chest injuries. Recognize flail chest, compression injuries, and broken ribs, and demonstrate appropriate first aid care for them. Recognize hemothorax, pneumothorax, tension pneumothorax, and open pneumothorax, and demonstrate appropriate first aid care. © 2012 Pearson Education, Inc.

Learning Objectives Describe the differences between open- and closed-abdominal wounds. Describe the common signs and symptoms, assessment, and first aid care, of abdominal injuries. Demonstrate appropriate first aid care for abdominal eviscerations, rupture (hernia), and injuries to male and female genitalia. © 2012 Pearson Education, Inc.

Chest Injuries Two types; open and closed –Closed (blunt): skin remains intact –Open (penetrating): skin is broken All chest injuries are potentially life-threatening; the most dramatic-looking injuries may not be the most life-threatening Types –Blunt trauma (caused by a blow) –Penetrating injury (an object penetrates) –Compression injury (chest cavity is rapidly compressed, as in a car accident) © 2012 Pearson Education, Inc.

Anatomy of the Chest Cavity © 2012 Pearson Education, Inc.

Chest Injuries: Signs and Symptoms Pale, cool, clammy skin Cyanosis (bluish coloring of lips, fingers or skin) Dyspnea (shortness of breath or trouble breathing) Rapid breathing Tracheal deviation (displacement to one side) Painful breathing Distended neck veins © 2012 Pearson Education, Inc.

Chest Injuries: Signs and Symptoms Pain at injury site Coughing up blood Failure of the chest to expand normally Rapid, weak pulse Open wound on the chest Bruising or deformity of the chest wall Altered mental status, such as confusion, agitation, restlessness, irrationality © 2012 Pearson Education, Inc.

Chest Injury Symptoms © 2012 Pearson Education, Inc.

First Aid Care for Chest Injuries First priority is to open and maintain the airway; provide rescue breathing if needed. Place an occlusive (watertight and airtight) dressing. Never try to remove impaled objects; instead, stabilize them and call EMS. If there is an impaled object –Expose the wound (remove or move clothing,etc.) –Dress wound around the object (control bleeding). –Stabilize the impaled object with bulky bandages or dressings. © 2012 Pearson Education, Inc.

Flail Chest Occurs when the chest wall becomes unstable Often results when two or more adjacent ribs are fractured in two or more places Can affect the front, back, or sides of the rib cage Should suspect possible lung tissue injury Considered a life-threatening injury Important to palpate the chest during assessment to check for a flail section Breathing may be impaired or heart compressed © 2012 Pearson Education, Inc.

Flail Chest © 2012 Pearson Education, Inc.

Compression Injury A life-threatening emergency Causes rapid pressure increase inside the chest Traumatic asphyxia occurs, causing blood to stop flowing or flow backwards © 2012 Pearson Education, Inc.

Compression Injury: Signs and Symptoms Pale, cool, clammy skin Weak, rapid pulse Difficulty breathing Distended neck veins Bloodshot, protruding eyes Bluish tongue and lips Swollen appearance of head, neck, shoulders © 2012 Pearson Education, Inc.

Broken Ribs Not inherently life-threatening but can cause injuries that are (organ puncture or laceration) Most common symptom is severe pain Ensure that the victim has an open airway and notify EMS Other symptoms include –Grating sound with palpation –Shallow, rapid breathing –Frothy blood at nose or mouth © 2012 Pearson Education, Inc.

Hemothorax and Pneumothorax Hemothorax: Accumulation of blood in the pleural space (fluid around lungs) Pneumothorax: Accumulation of air in the pleural space Both conditions cause lungs to collapse Three types of pneumothorax, all life-threatening –Pneumothorax –Open pneumothorax –Tension pneumothorax Activate EMS immediately. © 2012 Pearson Education, Inc.

Chest Injury Complications © 2012 Pearson Education, Inc.

Abdominal Injuries The abdominal cavity contains many vital organs and blood vessels Injuries are therefore often life-threatening Should also suspect possibility of chest trauma Solid organs can bleed profusely Hollow organs can spill contents Fluids spilled from abdominal organs pose risks for chemical or bacterial complications Closed abdominal wounds (blunt injury without skin breakage) pose grave risks for internal bleeding, shock, organ damage © 2012 Pearson Education, Inc.

Chest, Abdomen, and Pelvic Injuries © 2012 Pearson Education, Inc.

Abdominal Injury: Signs and Symptoms Bruising Tenderness (pain on palpation) Local pain (from mild to intense) Pain other than at injury site, or radiating to shoulder(s) Victim guards the area Victim assumes a fetal position Weak peripheral pulses Cramping © 2012 Pearson Education, Inc.

Abdominal Injury: Signs and Symptoms Abdomen is rigid or hard on palpation Nausea or vomiting Rapid, shallow breathing Rapid pulse Blood in urine Low blood pressure Distended or irregularly shaped abdomen Organs protruding through an open wound © 2012 Pearson Education, Inc.

Abdominal Injury: Signs and Symptoms © 2012 Pearson Education, Inc.

First Aid Care for Abdominal Injuries Prevent shock; keep victim warm (not hot). Control bleeding, dress all wounds. If object protrudes, uncover it, dress nearby wounds, stabilize it, and apply bulky dressings. Position the victim for greatest comfort. Watch for vomiting. Monitor vital signs constantly. Give the victim nothing by mouth. © 2012 Pearson Education, Inc.

Abdominal Evisceration Evisceration: the protrusion of abdominal contents (often intestines) from an open wound Activate EMS immediately. Cover organs with a sterile, moist dressing (must not cling or disintegrate). Cover with occlusive (waterproof) material. Prevent shock, monitor vital signs. Never touch abdominal organs or try to replace them in the cavity. © 2012 Pearson Education, Inc.

Rupture or Hernia Hernia: the most common kind of rupture; occurs when part of an organ protrudes through abdomen wall Most hernias occur in or just above the groin Result from abdominal wall weakness and/or muscle strain Symptoms: sharp pain, a feeling of “giving way” at rupture site, swelling, possible nausea and vomiting © 2012 Pearson Education, Inc.

Injuries to Genitalia Always act calmly and professionally with all victims. Male genital injuries –Very painful, but often not life threatening (unless there is uncontrolled bleeding) –Commonly include lacerations, avulsions, abrasions, penetrations, and contusions –Wrap body part in sterile dressing, control any bleeding, stabilize any object and apply bulky dressing –If an external object (like a zipper) is involved, try to remove it and apply ice for swelling. © 2012 Pearson Education, Inc.

Injuries to Genitalia Female genital injuries –External injuries can occur with straddle injuries, sexual assault, blows, abortion attempts, childbirth, or foreign object insertion –Due to the profusion of blood vessels and nerves, extreme pain and bleeding are frequent risks –Treatment: control bleeding, dress wounds, use an ice compress for pain –For sexual assault: do not allow the victim to bathe, wash hair, or clean under fingernails; try not to clean wounds; handle clothing minimally, put items in separate bags. © 2012 Pearson Education, Inc.

Summary All chest injuries are potentially life threatening. The priority for chest injuries is to ensure open airway and adequate ventilation. Compression injuries are life-threatening and cause rapid pressure increase inside chest. Never try to remove an impaled object in the chest or abdomen; stabilize to prevent movement and use bulky dressings. © 2012 Pearson Education, Inc.

Summary Abdominal injuries are extremely serious; closed wounds can indicate internal bleeding; open injuries risk bleeding and organ evisceration. Never touch protruding abdominal organs or try to replace them in the cavity. Few genital injuries are life-threatening unless they involve excessive bleeding. If a woman is a sexual assault victim, try to preserve the chain of evidence. © 2012 Pearson Education, Inc.