1. Lesson 6: Chest Injuries Emergency Reference Guide p. 47-50

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 of 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 or air escaping –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 or clavicle (aka collarbone)

5. Chest Injuries

6. 6

7. 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

8. 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

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 (i.e. tension pneumothorax) Suspicion of pneumothorax requires immediate (FAST) evacuation No treatment available 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, 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

12. 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

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 & 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 is important, since no effective field treatment is available in field

15. 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?

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