Chest Injuries
Chapter 27
Anatomy
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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
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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
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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
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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
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Treatment
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02
Tape a bulky pad against injury
Look for other injuries due to mechanism
Pulmonary Contusion
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Bruising of the lung
Usually caused by a blunt injury
Lung fills with fluid
Commonly seen with flail chest
Traumatic Asphyxia
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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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