CHEST INJURIES
The chest contains two of the body’s most important organs, the heart
and the lungs. If an injury to this area happens, it could be life
threatening especially if the rib cage is damaged.
Besides bruising and muscular aches, there are three particular types of
chest injuries:
- Fractured ribs
- Flail chest
- Penetrating chest wounds
These injuries are usually caused by blows, falls, crushing by heavy
objects or interference by others. E.g. gunshots, stabbing or explosions.
Fractured Ribs:
A simple rib fracture is rarely life-threatening but is painful. The greatest
risk associated with fractured ribs is that sharp, broken ends of the bone
that can cut or puncture he lungs or heart.
Note- patient must be kept still and protected from further blows or
sudden movements that might cause the broken rib ends to move.
Flail Chest:
Flail chest mostly occurs when a section of the rib cage is broken away
from the rest of the ribs. A section called “floats” in place and as the
patient breathes it moves in the opposite direction to the rest of the
chest, (Paradoxical breathing).
Penetrating Chest Wound:
A penetrating chest wound is an open wound, through which air can be
brought in and out of the chest cavity. This can lead to the collapse of a
lung and pooling of blood in the area. They can be any size depending on
the object that has caused the damage, may involve fractured ribs or
punctured lungs.
Signs and SypmtomsA flail chest has no visible wound; these can be cause due to a significant
blow whilst in a car accident. The person suffering from a flail chest will
experience chest pain, difficulty in breathing and shortness of breath,
they will most likely try gasp for air. You will also notice a blue colouring
of the mouth, nailbeds and skin. Patients may lose consciousness.
Fractured ribs also have no visible wound, it’s caused by a direct blow
such as being hit by a heavy object. Patient will experience chest pain
and will be taking short and rapid breaths plus experience tenderness at
the site of injury.
A penetrating chest wound is generally an open wound, cause by an
object piercing the body which might have been caused by a car accident
or knife attack. Patient will experience pain at the site of the wound and
experience pain and difficulty in breathing. You may hear the sound of
air being sucked into the chest and blood stained bubbles will be forming
around the wound. The patient may lose consciousness. Someone
suffering a penetrating chest wound they may also have fractured ribs or
a flail chest.
ManagementManagement of a Flail Chest:
1.
Follow DRSABCD.
2.
If patient conscious, place patient in a comfortable position
(normally half-sitting, leaning to the injured side)
3.
If patient unconscious, turn to the injured side, in a recovery
position.
4.
Loosen tight clothing.
5.
Place a large bulky dressing over the loose area with a firm
bandage.
Management of a Penetrating Chest Wound:
1.
Follow DRSABCD.
2.
Place patient in whatever position makes breathing easiest.
3.
Cover the wound – use the patient’s or your own gloved hand.
4.
Cover wound with a dressing, such as plastic sheet, bag,
aluminium foil or sterile dressing.
5.
Seal with tape on three sides (not bottom), to allow fluid to
escape.
6.
Call triple zero for an ambulance.
Management of Fractured Ribs:
1.
Follow DRSABCD.
2.
Place patient in comfortable position.
3.
Encourage the patient to breathe with short breaths.
4.
Gently place ample padding over the injured area.
5.
Apply one or two broad bandages, securing arm and padding to
chest on injured side.
6.
Tie bandages in front on uninjured side.
7.
Immobilise the arm using a St John sling or collar and cuff sling.
8.
Call triple zero for an ambulance.
Chest Injuries – Summary
Chest injuries are painful, complicated and potentially life threatening.
As a first aider you must concentrate on:
·
Ensuring that the patient's breathing and circulation are
maintained,
·
The injured parts are immobilised and
·
The patient is kept as comfortable as possible.
The most comfortable position, which will assist breathing, is half-sitting,
leaning to the injured side.
You should continue to monitor the patient's condition until medical aid
arrives. You should also treat a patient with chest injuries for shock.