Chest Trauma

LEARNING OUTCOME
Upon completion of this topic, students are able to understand:
1. Rib fractures
2. Flail chest
3. Pneumothorax (simple, open and tension)
4. Myocardial contusion
5. Cardiac tamponade
Chest Trauma
Second leading cause of trauma deaths after head injury
Accounts for 20% of all trauma deaths
Initial exam directed toward:
Open/tension pneumothorax
Flail chest
Massive hemothorax
Cardiac tamponade
Rib Fractures
Most common chest injury 1st/2nd rib fractures require high
force (30% death rate due to
Adults (elderly) more than aorta/bronchi injury)
children
8th to 12th rib fractures can cause
Most common 5thto 9th ribs underlying abdominal solid
(poor protection) organ damage
Signs & Symptoms
Localized pain, tenderness
Increases with cough, movement, and/or inspiration
Chest wall instability
Deformity, discoloration
Associated pneumo or hemothorax
Rib Fracture Management
ABCs, Oxygen
Splint using pillows, swathes,
Encourage patient to breath deeply
Monitor elderly/COPD patients carefully
Broken ribs can cause decompensating
Patients will fail to breath deeply and cough, resulting in failure to clear
secretions
Flail Chest
Two or more ribs broken in two or more places
Produces free-floating chest wall segment
Usually secondary to blunt force trauma
More common in elderly patients
Signs & Symptoms
Pain leading to decreased ventilation
Contusion of lung
Paradoxical movement
May not be present initially due to intercostal muscle spasms
Be suspicious with chest wall tenderness and crepitus
Flail Chest Management
Establish airway
Suspect spinal injuries
Assist ventilations with BVM/O2
Stabilize chest wall
Medics?
Simple Pneumothorax
Air in pleural space with partial or complete lung collapse
Causes:
Chest wall penetration
Fractured ribs
May occur spontaneously from coughing, exertion, air travel
Signs & Symptoms
Pain on inhalation
Difficulty breathing
Tachypnea
Decreased or absent breath sounds
Severity of symptoms depends on the size of pneumothorax, speed of
lung collapse, and patients health status
Simple Pneumothorax Management
Establish airway
Suspect spinal injury based upon MOI
High concentration O2 via NRB
Assist decreased or rapid respirations with BVM
Monitor for tension pneumothorax
Open Pneumothorax
Hole in chest wall
Allows air to enter the
pleural space
Larger hole increases
chance more air will
enter through hole than
through the trachea
Sucking chest wound/
SCW
SCW Management
Close hole with occlusive dressing
High concentration O2
Positive pressure ventilations with BVM
Consider placement on injured side
Monitor for tension pneumothorax
Tension Pneumothorax
One-way valve forms in lung or
chest wall
Air is trapped in pleural space
Pressure increases causing lung
collapse causing mediastinal
shift decreasing cardiac output
Signs & Symptoms
Extreme dyspnea
Restlessness, anxiety, agitation
Decreased breath sounds
Hyperresonanace to percussion
Cyanosis
Rapid, weak pulse
Decrease BP
Tracheal shift away from injured
side
Jugular vein distension
Subcutaneous emphysema
Tension Pneumothorax Management
Secure airway
High concentration O2 with NRB
Be ready to assist ventilations with BVM
Request ALS for pleural decompression
Hemothorax
Blood in the pleural
spaces
Most common result of
chest wall trauma
Present in 70% to 80%
of penetrating, major
non-penetrating chest
trauma
Shock precedes
ventilatory failure
Hemothorax Management
Secure airway
Assist ventilations with BVM/02
Rapid transport
Medics?
Myocardial Contusion
Bruising of the heart muscle
Most common blunt cardiac injury
Usually due to steering wheel
impact
May behave like an acute MI
May produce arrhythmias
May cause cardiogenic shock,
hypotension
Signs & Symptoms
Cardiac arrhythmias after blunt chest trauma
Angina-like pain unresponsive to NTG
Chest pain independent of respiratory movement
Suspect in all blunt chest trauma
Myocardial Contusion Management
High concentration O2 via NRB
Transport
Rapid transport
Medics?
Cardiac Tamponade
Rapid accumulation of
blood in the pericaridal
space
Heart is compressed
Blood flow entering heart
is decreased
Cardiac output falls
Signs & Symptoms
Hypotension
Increased venous pressure (distended neck/arm
veins in presence of decreased arterial pressure)
Muffled heart tones
Narrowing pulse pressure
Pulsus paradoxius
Cardiac Tamponade
Management
Secure airway
High concentration O2
Rapid transport
Medics? (pericardiocentesis)
Signs & Symptoms
Increase BP in absence of head injury
Decreased femoral pulses with full arm pulses
Respiratory distress
Ache in chest, shoulders, lower back, abdomen
Transporting Supine Patients
Maintain in-line stabilization.
Have the other team members position the
immobilization device.
Assess pulse, motor, and sensory function
Log roll/Seattle roll patient.
Secure patient to backboard.
Reassess pulse, motor, and sensory
function in each extremity
Transporting Sitting Patients
Maintain manual in-line stabilization.
Apply a cervical collar.
Place KED behind patient.
Position device around patient and secure.
Remove patient and lower to long backboard.
Secure KED and patient to backboard together.
Reassess the pulse, motor function, and
sensation.
QUESTION??