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
What are Signs & Symptoms a Chest injury?
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 & Caring for Chest Injuries (cont’d.)
Signs & 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 (aka collarbone)

5. Rib Injuries What are the Signs & Symptoms?
Pain in the clavicle or rib area
Complaints of increased pain with deep breathing
Discoloration, bruising or swelling
Guarding the injury from being touched/moved
Specific point where pain is most intense

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

7. 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 (i.e. tension pneumothorax)
Suspicion of pneumothorax requires immediate (FAST) evacuation
No treatment available in wilderness setting for a lung injury

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

9. Sucking Chest Wound
Characterized by open wound that bubbles & makes noises when breathing
Do not remove impaled objects. Immobilize & seal wound(s)
Apply Occlusive dressing
Apply Air barrier (i.e. plastic baggie, etc.)
One corner is left open to allow air to escape

10. 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 & transport patient for:
Increase difficulty breathing
Flail chest
Sucking chest wound
Transport on side with injury or other position of comfort.

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

12. SHOUT OUT
What are some possible chest injuries you can anticipate in a Wilderness or remote location?
What are some smart ways to help prevent chest injuries?

13. What else can be added to the First Aid Kit?
Questions?
What else can be added to the First Aid Kit?