COURSE SUMMARY
ANNEX: B
COURSE: MEDICAL
PHASE: 1 VER: C
PREPARATION DATE: 2012/01/26
COURSE TITLE: TREAT UNIT CASUALTIES
REFERENCES: ANA-STP-8-86C-E4-5-SM-TG / (U.S. DOCTRINE STP 8-91W15-SM-TG)
ACADEMIC TITLE
TREAT A CASUALTY WITH A CLOSED CHEST INJURY
HOURS
081-86A-0049
Terminal Learning Objective:
Understand how to treat a closed chest wound, minimizing the effects of the injury, without
causing additional injury to the casualty.
Enabling Learning Objectives:
1. Soldier understands how to check casualties for signs and symptoms of chest injuries.
2. Soldier understands how to determine the type of injury.
3. Soldier understands how to initiate treatment for a chest injury.
4. Soldier understands how to treat the casualty for shock.
5. Soldier understands how to record the care provided on the appropriate form.
6. Soldier understands how to evacuate the casualty.
7. Soldier understands how to prevent further injury to the casualty.
4 HRS
TREAT A CASUALTY WITH A CLOSED CHEST WOUND
081-86A-0049
Conditions: All other more serious injuries have been treated. Necessary materials and
equipment: cravats, field jacket, poncho, blanket, or similar material, and oxygen.
Standards: Treated a closed chest wound, minimizing the effects of the injury, without causing
additional injury to the casualty.
Performance Steps
1. Check the casualty for signs and symptoms of closed chest injuries.
a. Pleuritic pain that is increased by or occurs with respirations and is localized around the
injury site.
b. Labored or difficult breathing.
c. Diminished or absent breath sounds.
d. Cyanotic lips, fingertips, or fingernails.
e. Rapid, weak pulse and low blood pressure.
f. Coughing up blood or bloody sputum.
g. Failure of one or both sides of the chest to expand normally upon inhalation.
h. Paradoxical breathing--the motion of the injured segment of a flail chest, opposite to the
normal motion of the chest wall.
i. Enlarged neck veins.
j. Bulging tissue between the ribs and above the clavicles.
k. Tracheal deviation--shift of the trachea from the midline toward the unaffected side due to
pressure buildup on the injured side.
l. Mediastinal shift--shift of the heart, great vessels, trachea, and esophagus from the midline
to the unaffected side due to pressure buildup on the injured side.
WARNING: Evidence of mediastinal shift indicates excessive pressure within the chest cavity.
Compression of the heart and great vessels will impair blood flow through the heart. Immediate
relief of the pressure (chest decompression) must be accomplished by trained medical
personnel or death will result.
2. Determine the type of injury.
a. Rib fracture--generally caused by a direct blow to the chest or compression of the chest.
Severe coughing can also cause rib fracture.
(1) Signs and symptoms.
(a) Pain is aggravated by respirations and coughing.
(b) Crepitus is present.
(c) The casualty will take a defensive posture to protect the injury.
(2) Complications.
(a) Internal bleeding (hemothorax).
(b) Shock.
(3) Treatment.
(a) Use a sling and swathe to immobilize the affected side.
(b) Administer oxygen as necessary.
NOTE: The broken rib may puncture the lung or the skin.
WARNING: Do not tape, strap, or bind the chest.
b. Flail chest involves three or more ribs fractured in two or more places or a fractured
sternum.
(1) Signs and symptoms.
(a) Sever pain at the site.
(b) Rapid shallow breathing.
(c) Paradoxical respirations.
(2) Complications.
(a) Respiratory insufficiency.
(b) Traumatic asphyxia.
(3) Treatment.
(a) Establish and maintain an airway.
(b) Administer oxygen.
(c) Assist the casualty's respirations, if necessary.
(d) Monitor the casualty for signs of hemothorax or tension pneumothorax, as necessary.
(e) Stabilize the flail segment using one of the following methods:
1) Apply manual pressure.
2) Tape a pillow, folded blanket, field jacket, or poncho in place.
3) Place the casualty on the injured side.
WARNING: Do not wrap the casualty's chest with tape. This will interfere with the casualty's
ability to breathe.
c. Hemothorax is caused by the bleeding from lacerated blood vessels in the chest cavity
and/or lungs. It results in the accumulation of blood in the chest cavity but outside the lungs.
(1) Signs and symptoms.
(a) Hypotension due to blood loss.
(b) Shock.
(c) Cyanosis.
(d) Tightness in the chest.
(e) Mediastinal shift may produce deviated trachea away from the affected side.
(f) Coughing up frothy red blood.
(2) Complications.
(a) Possibility of hypovolemic shock.
(b) Frequently accompanies a pneumothorax.
(3) Treatment.
(a) Establish and maintain an airway.
(b) Administer oxygen.
(c) Assist the casualty's breathing, as necessary.
d. Injuries to the back of the chest can result from a direct blow on the back of the chest.
Contusions or rib fractures may occur.
WARNING: Spinal injury should be suspected.
(1) Signs and symptoms.
(a) Rib fracture.
(b) Lacerations on the back.
(c) Muscle strain.
(d) Fractured scapula.
(e) Spinal injury.
(f) Respiratory distress.
(2) Complications.
(a) Spinal injury.
(b) Hemothorax.
(c) Pneumothorax.
(3) Treatment.
NOTE: The main concern with this injury is the spine.
(a) Establish and maintain an airway.
NOTE: Use the jaw thrust technique if a spinal injury is suspected.
(b) Administer oxygen.
(c) Assist the casualty's respirations, if necessary.
(d) Treat suspected spinal injuries.
e. Tension pneumothorax.
(1) Condition in which air enters the chest cavity (pleural space) through a hole in the
lung(s), expanding the space with every breath the casualty takes.
(2) The air becomes trapped and cannot escape.
(3) Increased pressure in the chest causes the lung(s) to collapse.
(4) May result from the laceration of the lung by a broken rib or by spontaneous rupture of
a bleb or lesion on the lung.
(5) Position the casualty for evacuation.
(a) Conscious--in a comfortable position.
(b) Unconscious--on the injured side.
(6) Treatment.
(a) Establish and maintain an airway.
(b) Administer oxygen.
(c) Assist the casualty's respirations, as necessary.
(d) Monitor the casualty for evidence of a mediastinal shift.
3. Treat the casualty for shock.
4. Record the care provided on the appropriate form.
5. Evacuate the casualty.
NOTE: Continue to assess the casualty, if necessary.
Evaluation Preparation:
Setup: For training and evaluation, have another soldier act as the casualty. To test step 1, have
the soldier tell you the signs of a closed chest wound.
Brief soldier: Tell the soldier to treat a casualty with a closed chest wound. Tell the soldier
whether the wound involves a simple rib fracture, a flail chest, a compression injury, an injury to
the back of the chest, a pneumothorax, or a hemothorax.
Performance Measures
1. Checked the casualty for signs and symptoms of closed chest injuries.
2. Determined the type of injury.
3. Initiated treatment for a closed chest injury.
4. Treated the casualty for shock.
5. Recorded the care provided on the appropriate form.
6. Evacuated the casualty.
7. Did not cause further injury to the casualty.
PASS
——
——
——
——
——
——
——
FAIL
——
——
——
——
——
——
——
Evaluation Guidance: Score each soldier according to the performance measures in the
evaluation guide. Unless otherwise stated in the task summary, the soldier must pass all
performance measures to be scored PASS. If the soldier fails any step, show what was done
wrong and how to do it correctly.