Lesson 6:
Chest Injuries
Emergency Reference Guide p. 47-50
Objectives
• Demonstrate a field assessment of a person
with a chest injury
• Describe the emergency treatment and long
term care of:
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Fractured rib/clavicle
Pneumothorax
Tension pneumothorax
Fail Chest
Sucking Chest Wound
Describe when to evacuate SLOW vs. FAST
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
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)
Chest Injuries
Chest Injuries
6
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
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
Rib Injury Care
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
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
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
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:
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Increase difficulty breathing
Flail chest
Sucking chest wound
Transport on side with injury or other position of
comfort.
Preventing Chest Injuries
• Prevention is important, since no effective
field treatment is available in field
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?
Questions?
What else can be added to the First Aid Kit?