CHEST
Anatomy
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Overview of Chest Injuries
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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
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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
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Closed Chest Injuries
Rib fracture
 Flail chest
 Pneumothorax
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Rib Fracture
Rib fractures are almost always the result of
trauma (a blow) to the rib cage
 Signs and Symptoms
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 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
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Rib Fracture
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Treatment
 Give oxygen
 Make the patient as comfortable as possible
 Activate EMS and treat as Load and Go
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Transport patient
 in the position of maximum comfort on the injured
side
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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
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Flail Chest
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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
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Flail Chest
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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
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Use of Dressings on a Flail Chest
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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
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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
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Pneumothorax
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Is a condition that results from air entering the
interpleural space. The air in the interpleural
space compresses the lung and prevents normal
breathing.
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There are two types of pneumothorax:
 Tension pneumothorax
 Spontaneous pneumothorax
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Pneumothorax
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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
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Pneumothorax
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Treatment for Tension Pneumothorax
 Give oxygen
 Activate EMS and treat as Load and Go
 Continue to monitor vital signs
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Treatment for Spontaneous Pneumothorax
 Give oxygen
 Transport to medical aid
 The patient may prefer to be transported sitting up.
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Open Chest Injuries
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In penetration injuries of the chest wall, air can
enter the interpleural space from the outside,
causing the lung to collapse
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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
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Open Chest Injuries
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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
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Open Chest Injuries
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Treatment
 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
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Transport the patient
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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
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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
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 Impaled objects are easily identified by sight
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Impaled Objects
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Treatment
 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
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Transport the patient
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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
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