1. CHEST

2. Anatomy

3. Overview of Chest Injuries
Can be life-threatening
May result in damage to either the heart or the lung and cause severe internal bleeding
Rib cage fractures may result in serious injury to vital organs
Deep, open wounds allow air to enter the chest cavity
Closed wounds usually involve injury to the ribs and possibly underlying structures

4. Signs of Chest Injuries
An obvious chest wound
Impaired breathing
Irregular – or lack of – chest expansion
Coughing-up of blood
Shock
Subcutaneous emphysema: crackling sensation
Of all signs, a change in the normal breathing pattern is the most indicative of chest injury.
A patient who has breathing difficulty will usually move in to a position where breathing is easiest. Typically this will be either sitting or reclining.

5. Closed Chest Injuries
Rib fracture
Flail chest
Pneumothorax

6. Rib Fracture
Rib fractures are almost always the result of trauma (a blow) to the rib cage
Signs and Symptoms
leaning toward the injured side
if the rib has punctured a lung, air can escape into the tissues of the chest wall creating a crackling sensation (- Subcutaneous Emphysema)
unwillingness to take a deep breath
complaining of local pain and tenderness
pain when moving the rib cage when breathing or coughing

7. Rib Fracture Treatment Transport patient Give oxygen
Make the patient as comfortable as possible
Activate EMS and treat as Load and Go
Transport patient
in the position of maximum comfort on the injured side

8. Flail Chest
Several adjacent ribs fractured in more than one place can produce a loose section of the chest wall
The flail section moves inward when the patient breathes in, and outward when the patient breathes out
This phenomenon is known as paradoxical movement

9. Flail Chest Signs and symptoms shortness of breath
swelling over the injury site
shock
muscle splinting of the injury site
severe pain on inhalation/exhalation
possible paradoxical movement

10. Flail Chest Treatment Give oxygen as soon as possible
Be prepared to give AR
Help the patient get in a comfortable position and transport to medical aid.
Activate EMS and treat as Load and Go
Continue to monitor vital signs
Unless there is substantial bleeding, do not apply bulky padding or dressings

11. Use of Dressings on a Flail Chest
Only consider taped-on pad as a treatment in the following cases:
if there is likely to be a prolonged time before evacuation and access to medical care
if the patient has fatigued their chest muscles
To apply dressings
Press the segment inward with your gloved hand to stabilize it
Splint in the inward position with a pillow, large bulky dressing, or folded blanket or parka
Secure this thoroughly in place with tape
Be prepared to help breathing with AR
Do not hold in place with bandages encircling the chest. This would further impair the patient’s breathing effort
The tape reduces the mobility of the chest wall and thus limits the already compromised expansion of the lung.

12. Pneumothorax
Is a condition that results from air entering the interpleural space. The air in the interpleural space compresses the lung and prevents normal breathing.
There are two types of pneumothorax:
Tension pneumothorax
Spontaneous pneumothorax

13. Pneumothorax Signs and symptoms
reduction of normal respiratory movements on the affected side
a fall in blood pressure
weak and rapid pulse
a sudden sharp chest pain

14. Pneumothorax Treatment for Tension Pneumothorax
Give oxygen
Activate EMS and treat as Load and Go
Continue to monitor vital signs
Treatment for Spontaneous Pneumothorax
Transport to medical aid
The patient may prefer to be transported sitting up.

15. Open Chest Injuries
In penetration injuries of the chest wall, air can enter the interpleural space from the outside, causing the lung to collapse
Air moving back and forth through the chest wall results in what is often called a sucking chest wound, because of the sucking sound during inhalation
Important Notes
If the chest wall is punctured, air can enter the pleural cavity and the patient can develop Pneumothorax (see Pneumothorax, above). If open chest injuries are not treated properly, they can result in tension pneumothorax.

16. Open Chest Injuries Signs and symptoms
increasing difficulty in breathing
frothy blood at the mouth/site of wound
rapid, weak pulse
cyanosis
falling blood pressure
localized chest pain

17. Open Chest Injuries Treatment Transport the patient
Seal the wound with any airtight material
Tape the material in place on three sides. Leave the bottom (based on patient position) side unsealed to release accumulated air
Continually monitor the “dressing” to ensure that the seal is effective on inspiration only
Transport the patient
in a position of comfort
in a position which will not impair breathing
give oxygen
monitor vital signs
activate EMS and treat as Load and Go

18. Impaled Objects
Impaled objects are things such as broken glass or large splinters that are both embedded into and protruding from the body
Signs and Symptoms
Impaled objects are easily identified by sight

19. Impaled Objects Treatment Transport the patient
do not move or remove the object
build up a dressing around the object to hold it in place during transportation
tape the dressing in place
Transport the patient
in the most comfortable position possible
monitor respiration transport to medical aid immediately.
activate EMS and treat as Load and Go
continue to monitor vital signs
If the object is obviously dangling from the skin or will cause extreme further damage, it should be removed