Ch. 9-Injuries to the Chest,
Abdomen, and Genitalia
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9.1 Chest Injuries
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Blunt trauma (caused by a forceful blow to
the chest)
Penetrating injury (an object penetrates the
chest wall)
Compression injury (the chest cavity is
compressed rapidly, usually during an
automobile accident)
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General Signs and Symptoms of Chest
Injury
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Pale, cool, clammy skin
Cyanosis (bluish coloring of the fingernails, fingertips, lips, or skin)
Dyspnea (shortness of breath or difficulty breathing)
Rapid breathing (more than 20 breaths per minute)
Tracheal deviation
Pain during breathing
Distended neck veins
Pain at the injury site, or pain near an injury that
is made worse by breathing
Coughing up of blood (hemoptysis), usually
bright red and frothy
Failure of the chest to expand normally during inhalation
Shock
Rapid, weak pulse (more than 100 beats per minute)
Open wounds to the chest
Bruising or deformity to chest wall
Changing mental status, including confusion, agitation, restlessness
or irrational behavior
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Vocabulary
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Dyspnea- Shortness of breath or difficulty in
breathing
Tracheal deviation- Displacement of the trachea
to one side or the other
Hemoptysis- Coughing up of blood
Flail chest- Instability of a section of chest wall
Paradoxical movement- A condition in which the
injured area of the chest moves opposite the
rest of the chest during breathing
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General First Aid Care Principles for
Chest Injuries
Activate the EMS system immediately; then follow these steps:
1. Your first priority is to open the airway if necessary; ensure
adequate ventilation.
2. Place an occlusive dressing over any open wounds to the
chest; control external bleeding.
3. Never try to remove an impaled object; stabilize it to
prevent movement until the victim can receive medical help.
4. If there is an object impaled in the chest:
• Cut away clothing to expose the wound.
• Dress the wound around the impaled object to control
bleeding and control a sucking chest wound.
• Stabilize the impaled object with rolls of self-adhering
bandages or bulky dressings.
• Tape bandages in place to stabilize the impaled
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object.
PROGRESS CHECK
1. One of the two most important signs of chest injury is a
change in ____________. (skin color/normal breathing
pattern)
2. One of the two most important signs of chest injury is the
____________ rate. (respiratory/heart)
3. The first priority in caring for a victim of chest injury is to
____________. (control bleeding/ensure adequate
ventilation/prevent further injury)
4. You should ____________ an impaled object in the chest.
(remove/stabilize, then remove/immobilize and leave in
place)
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9.2 Specific Chest Injuries
Flail Chest
Immediately activate the EMS system; then:
1. Maintain an open airway and administer artificial ventilation
if the breathing is inadequate.
2. Use gentle palpation to locate the edges of the flail section;
stabilize with a pad of dressings or a pillow. Secure with
wide tape.
3. Position the victim with the flail segment against an external
support in a semi-sitting position or lying in a supine
position with the segment splinted with the arm.
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Compression Injuries and Traumatic
Asphyxia
Signs and symptoms
include:
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Pale, cool, clammy skin
Weak pulses
Increased heart rate
Increased breathing rate
Distended neck veins
Bloodshot, protruding eyes
Cyanotic tongue and lips
Coughing or vomiting blood
First Aid Care
Activate the EMS system immediately,
then:
1. Maintain an open airway and
administer artificial ventilation if
breathing is inadequate.
2. Control any bleeding that results from
the trauma.
3. Monitor the victim closely; position
the victim in a supine position.
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Broken Ribs
Signs and symptoms
include:
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Severe pain at the fracture site
Grating sound upon palpation
(crepitus)
Chest deformity
Shallow, rapid breathing
Bruising or lacerations at the
suspected fracture site
Frothy blood at the nose or
mouth (indicating lung
laceration)
First Aid Care
Activate the EMS system immediately,
then:
1. Use a sling and swathe to utilize the
victim’s arm as a splint and support
the forearm of the injured side
positioned across the chest
2. Position the victim in a supine
position.
3. Monitor the victim’s ABCDs, watching
for signs of internal bleeding that
could lead to shock.
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Vocabulary
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Traumatic asphyxia- Sudden compression of the chest
wall that forces blood to flow the wrong way.
Crepitus- A sandpaperlike grating sound made by the ends
of a broken bone as they rub together
Hemothorax- An accumulation of blood in the chest cavity
Tension pneumothorax- A situation in which air enters
the pleural space through a oneway defect in the lung,
resulting in a progressive increase in pressure in the pleural
cavity that causes the lung to collapse and that impairs
circulation
Pneumothorax- A condition in which air from a lung
or from the outside fills the chest cavity, but does
not fill the lung.
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PROGRESS CHECK
1. In flail chest, the chest wall ____________ when the victim exhales.
(collapses/moves/protrudes)
2. Flail chest most often occurs when multiple ____________ are
fractured. (bones/ribs/joints)
3. To check for flail chest, have the victim lie on his or her back and check
for ________ as the victim breathes. (crepitus/pain/paradoxical
motion)
4. Traumatic asphyxia occurs from sudden ____________ of the chest
wall. (compression/collapse/penetration)
5. The most common symptom of rib fracture is ____________.
(deformity/pain/bruising)
6. The greatest priority in treating rib fracture is to splint the chest so the
victim ____________. (can breathe adequately/is not in pain/will not
be further injured by broken bone ends)
7. In treating a rib fracture, you should use ____________.
(tape/continuous strapping/a sling and swathe)
8. In a hemothorax, ____________ enters the chest cavity.
(air/blood/pressure)
9. To help prevent tension pneumothorax, you should always
leave one corner of a chest bandage ____________.
(over the wound/untaped/ at least 2 inches beyond the
wound)
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9.3 Abdominal Injuries
To assess a victim for abdominal injury:
1. Have the victim lie supine with knees flexed and
supported; remove or loosen clothing over the
abdomen.
2. Inspect for lacerations, open wounds, bruising,
impaled objects, or protruding abdominal organs.
3. Gently palpate all four quadrants for guarding,
rigidity, pain, and tenderness.
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Signs and Symptoms of Abdominal
Injuries
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Distended or irregularly shaped abdomen
Bruising of the abdomen flank or back
Tenderness (pain on palpitation)
Pain, ranging from mild discomfort to intense, intolerable pain
Pain other than at the injury site
Pain radiating to either shoulder
“Guarding” (voluntary contraction of the abdominal muscles)
Fetal position or lying with legs drawn up toward the chest and abdomen
Weak peripheral pulses
Abdominal cramping
A rigid, boardlike, stiff or hard abdomen on palpation
Nausea and/or vomiting; the victim may vomit blood
Rapid, shallow breathing
Rapid pulse
Open wounds and penetrations
Organs protruding through open wounds
Blood in the urine
Extreme weakness
Thirst
Low blood pressure
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General First Aid Care
1. Take measures to prevent shock; keep the victim warm, but do not
overheat.
2. Control bleeding and dress all open wounds with a dry, sterile dressing.
3. If any object has penetrated or impaled the victim
• Cut clothing away from the object.
• Dress the wounds around the object to control
bleeding.
• Stabilize the object with bulky dressings.
• Bandage the object in place to prevent
movement.
4. Position the victim for greatest comfort; victims may want to lie on the
back with the knees flexed. If possible, elevate the feet.
5. Be alert for vomiting; position the victim for adequate drainage.
Constantly monitor vital signs and abdominal condition.
6. Do not give the victim anything by mouth.
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Abdominal Evisceration
Activate the EMS system, then:
1. Cover protruding abdominal organs with a clean
dressing moistened with sterile water if possible or
clear water that is clean enough to drink.
2. Cover the moist dressing with an occlusive material,
such as clean plastic wrap, to retain moisture and
warmth.
3. Prevent shock, and constantly monitor the victim’s
vital signs.
Never touch abdominal organs or try to replace
them in the abdominal cavity.
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Rupture or Hernia
Signs and symptoms
include:
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Sharp, stinging pain
Feeling of something
giving way at the site of
the rupture
Swelling
Possible nausea and
vomiting
First Aid Care
Activate the EMS system immediately,
then:
1. Position the victim on his or her back
with the knees well drawn up, and
place a blanket or other padding
under the knees.
2. Cover the victim with a blanket to
preserve body warmth.
Never try to force a protrusion back
into the abdominal cavity.
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Vocabulary
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Evisceration- The protrusion of abdominal
contents through a laceration or other
wound
Hernia- Protrusion of an internal organ
through the abdominal wall or into another
body cavity
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PROGRESS CHECK
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1. The amount of ____________ does not necessarily
indicate how serious abdominal injury is.
(pain/external blood/deformity)
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2. Most abdominal injury victims are most comfortable on
their back with the ____________. (feet elevated/head
elevated/knees drawn up)
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3. If abdominal organs protrude through a wound, you
should ____________ them.
(cover/replace/remove)
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9.4 Injuries to the Genitalia
Male Genitalia
1. Wrap the penis or scrotum in a soft, sterile dressing moistened with
sterile or clean water.
2. If there is a penetrating or impaled object, do not remove it
3. If part of the penis or scrotum is caught in a zipper, cut off the zipper
fastener and separate the teeth
4. Apply an ice bag or cold compresses to relieve pain and reduce swelling.
5. If there are avulsed parts, wrap in sterile gauze moistened with clean
water and send them with the victim.
Female Genitalia
1. Control bleeding with direct pressure.
2. Dress the wounds, keeping the dressing in place with a diaper-type
bandage. Stabilize any impaled objects or foreign bodies.
3. Use ice packs or cold compresses to relieve pain and
reduce swelling.
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PROGRESS CHECK
1. In both male and female victims with injuries to the
genitalia, apply ____________ to relieve pain and reduce
swelling. (direct pressure/an ice bag/sterile gauze)
2. Always try to ____________ avulsed skin.
(preserve/finish detaching/clean)
3. If a woman was the victim of sexual assault, try to
____________. (comfort her/find the assailant/preserve the
chain of evidence)
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