Chest Injuries - Metro EMS

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					                                Chest Injuries
                                        Chapter 27

Anatomy
   -   Extends from the lower end of the neck to the diaphragm
   -   Diaphragm may extend to as high as the nipple line during exhalation
   -   Contents of the chest are protected by the ribs
   -   Ribs are connected to the spine in the back and the sternum in the front
   -   Contains: Heart, Lungs, Aorta, Subclavian arteries, Superior/Inferior vena cava,
       Esophagus, Trachea, Diaphragm

Injuries of the chest
   -   Closed – One in which the skin is not broken
                 Generally caused by blunt trauma
                 Usually injures a large area
   -   Open – The chest wall itself is penetrated by an object
                 Usually injures a small area

Pneumothorax (spontaneous)
                 Air in the pleural space due to non-traumatic cause
                 Lung partially collapses
                 Usually not serious
       Assessment findings
                 Sudden sharp chest pain and dyspnea without a specific known
                   cause
       Signs/symptoms
                 Chest pain (sharp)
                 Dyspnea
                 Tachypnea
                 Decreased/absent lung sounds on affected side
       Treatment
                 02
                 Position of comfort
                 Frequent reassessment (watch for tension)

Tension Pneumothorax
                    Air in the pleural space which increases the tension or pressure on
                     the organs of the chest
                    Lung collapses
                    Pushes organs away from affected side
                    Compression of the vena cava prevents blood from returning to the
                     heart




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      Signs/symptoms
                Rapid onset of Dyspnea
                Tachypnea
                Tachycardia
                Hypotension
                Absent lung sounds on affected side
                JVD (difficult to see)
                Tracheal deviation (extremely late sign)
      Treatment (open or sucking chest wound)
                Open and clear the airway
                02
                Seal the wound with an occlusive dressing
                May have to lift dressing occasionally to relieve pressure
      Treatment (closed)
                Open and clear the airway
                02
                Drive faster

Hemothorax – Blood accumulates in the pleural space
Hemopneumothorax – Combination of blood/air in the pleural space
Rib Fractures
                Most common chest injury
                #5 - #8 most commonly injured
                Any fracture above #4 indicates severe mechanism
      Signs/symptoms
                Pain with movement/palpation/breathing
                Shallow/rapid respirations due to pain with breathing
                Crepitus (difficult to feel)
                Subcutaneous emphysema if lung is penetrated by broken rib
      Treatment
                02
                Reassess frequently
                Patient will usually self-splint, can use a sling/swathe

Flail Chest
                 3 or more ribs fractured in 2 or more places or multiple rib fractures
                  involving the sternum
                Muscle spasm may stabilize the fractured segment for 24 – 48
                  hours
      Assessment findings
                Paradoxical motion – The injured portion of the chest wall moves in
                  the opposite direction than normal
      Signs/symptoms
                Same as for fractured rib
                Pain will be more severe


                                                                                       2
     Treatment
                  02
                  Tape a bulky pad against injury
                  Look for other injuries due to mechanism

Pulmonary Contusion
                  Bruising of the lung
                  Usually caused by a blunt injury
                  Lung fills with fluid
                  Commonly seen with flail chest

Traumatic Asphyxia
                Severe blunt trauma to the chest in which blood is forced from the
                 heart into the head/upper chest
     Signs/symptoms
               JVD
               Cyanosis of the face and neck
               Blood in the white of the eye
     Treatment
               02
               Frequent reassessment
               Rapid transport

Myocardial Contusion
               Heart is crushed between sternum/spine
     Signs/symptoms
               May not be any signs/symptoms other than mechanism
               Patient may present like an MI
               Irregular pulse possible
               Unexplained Tachycardia
     Treatment
               Treat as you would an MI after assessing for all other causes of
                 chest pain if present

Pericardial Tamponade
               Blood or other fluid collects in the pericardium
               Most often caused by penetrating trauma
     Signs/symptoms
               Narrowing pulse pressure
               Muffled heart tones
               JVD
               Weak pulse
     Treatment
               02
               Rapid transport




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Laceration of the great vessels
        o Superior/inferior vena cava
        o Aorta
        o Pulmonary vessels
               Causes massive bleeding
               Blood loss may not be obvious externally
     Assessment findings
               Any patient with a chest injury (blunt or penetrating) with
                 signs/symptoms of shock
     Treatment
               02
               Rapid transport


  Anything below the nipple and above the umbilicus
   should be considered abdominal as well as chest




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