1. Lesson 6: Chest Injuries

2. 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

3. 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

4. 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

5. Chest Injuries

6. Chest Injuries

7. 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

8. 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

9. Rib Injury Care

10. 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

11. 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

12. 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

13. 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.

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