Chest Trauma

Organs/Vessels
n Thoracic cavity
u Ribs

u Diaphragm

u Mediastinum (trachea, vena cava, aorta,

esophagus, heart)
u Lungs
Chest Anatomy
Pleura
n 2 Layers
u Keep lungs expanded

u Visceral layer

u Parietal layer

n Pleural space
u Small amount of fluid
Pericardial Cavity
n Fibrous pericardium
n Epicardium
n Potential space - < 50 ml of fluid
Other Considerations

Liver and spleen located under lower ribs

Trauma Below nipples – Assume abdominal injuries
Trauma Above nipples – Assume cervical spine injury
Always consider spinal column trauma
GSW can damage both cavities
Chest and abdominal trauma victims get high flow oxygen
Other Considerations
n Major chest and abdominal trauma
regularly occur together
n When you see one, look for the other
n I bet you will find it
Hypoxia Consideration
(End Point)
n Airway obstruction inadequate oxygendelivery
n Hypovolemia from blood loss
n Ventilation/perfusion mismatch from lung
 injury
n Changes in pleural pressures
n Pump failure  Manage hypoxia!!
 Airway control

 Rapid Transport


Trauma Injury Effects
n
n
n
n
n
 Deadly Dozen
n Airway obstruction Traumatic aortic rupture

n Open pneumothorax Tracheal/bronchial tree

n Tension pneumothorax injury

n Massive hemothorax Myocardial contusion

n Flail chest Diaphragmatic tears

n Cardiac tamponade Esophageal injury

Pulmonary contusion


 CLOSED CHEST INJURY
n Closed (Blunt) – Falls, automobile crashes, direct blows to
the chest
u Force distributed over large area
OPEN CHEST INJURY
n Open (Penetrating) –
Knife, GSW, ice
picks, broken glass,
nails
u Force distributed

over a small area

Blunt Trauma
Penetrating Trauma
Pneumothorax
n Blunt or penetrating trauma
n Chest wall penetrated and air flows into the
thoracic cavity around the lungs
n Visceral and parietal pleura – air in pleural
space collapses the lung
n No penetration possible (broken rib), lung
laceration - most common
Pneumothorax
Pneumothorax RX
n Oxygen
n Reassessment (tension pneumothorax
possible)
n Transport
Sucking Chest Wound
n Penetrating trauma
n An open chest wound that sucks air into the
wound; a noticeable sucking sound may be heard.
u Additional air being sucked into cavity

u Trapped air

n Cover with gloved hand, or occlusive dressing

(tape 3 sides)
n Life Threat
Sucking Chest Wound
Tension Pneumothorax
n Blunt or penetrating
n When air builds up collapsing one or both
lungs
u Can compresses large vessels and heart
n High flow oxygen
n Reassessment
n Rapid transport
n Open sucking wound? Occlusive dressing –
3 sides taped
Rib Fractures

n Pain
n Most commonly blunt trauma
n Most commonly injured
n Reduced chest excursion – limits ventilation
n Consider pulmonary and/or myocardial contusions
n Consider pneumo/hemothorax
Rib Fractures S/S
n Dyspnea
n Shallow respirations
n Guarding (self splinting)
n Painful respirations
n Tender, unstable ribs
Rib Fractures RX
n Oxygen
n Splint?
n Reassessment
n Transport
n Major force involved
n Two or more adjacent ribs are broken in two or more
places
n Unattached segment (flail segment)
n Paradoxical movement (opposite movement of the rest of
the chest)
n Consider underlying injuries
n Stabilize with hand initially, splint later
n Life Threat
Flail Segment S/S
n Tenderness, unstable segment
n Dyspnea
n Shallow respirations
n Guarding (self splinting)
n Painful respirations
n Paradoxical movement
n Shock
Flail Segment R/X
n Provide high flow oxygen
n Assist ventilations, if required
n Stabilize flail segment (hand then bulky
dressings)
n Reassessment – Consider underlying
injuries
n Rapid Transport
n Penetrating and blunt trauma
n Rapid accumulation of blood in the chest
(greater than 1500 ml)
n Chest cavity can hold entire blood content
n Cyanosis
n Flat neck veins
n Respiratory distress
n Shock
n Cold clammy skin
n Breath sounds absent, hypo resonant
Hemothorax RX
n High flow oxygen
n Ventilate, as needed
n Rapid assessment
n Reassessment
n Rapid Transport
Traumatic Asphyxia
n Severe crush injury (blunt force) to the
chest
n Compression of the superior vena cava
n Petechiae present
n Cerebral edema
n Head and neck swelling (tongue and lips)
n Conjunctival hemorrhage
Traumatic Asphyxia S/S
n Swollen tongue, lips
n Bloodshot eyes
n Protruding eyes
n Chest trauma (blunt force)
Traumatic Asphyxia RX
n CPR
n CABC
n High flow oxygen
n Ventilate
n Rapid transport
 Pericardial Tamponade
n Penetrating trauma common
n Blood filling the pericardial sack
n 15 ml – 20 ml of fluid removal may be life
saving
Pericardial Tamponade S/S
n Beck’s Triad
u Distended neck veins

u Muffled heart sounds

u Hypotension

n Tachycardia
n Narrowed pulse pressure
n Trachea midline
n Normal breath sounds
Pericardial Tamponade RX
n High flow oxygen
n Ventilate, as needed
n Rapid transport
n Reassessment
n Stabilize with dressings, build up around object
n Do not remove
Relevant Chest Trauma
SAMPLE History
n GSW
u Caliber, distance, number of shots, angle

n Stab Wounds
u Length of blade, type of blade
(smooth/serrated), sex of the stabber
n Falls
u Height, surface landed on, body part
landed on
Assessment Techniques
Page 954 & 956

n Inspection (observation) – DCAP BTLS

n Palpation (touch) – Instability
n Percussion (sound waves) – Striking an
object and listening to the sound made
n Auscultation (listening) – Stethoscope;
breath sounds, heart tones
Palpation
Auscultation
Assessment Techniques
n Vital signs
u BP

u Pulse

u Respirations

u Body Temperature
MOI Considerations
n Page 217– “Scene Size- up” section
u Automobile crash – steering wheel

u Sports accident

u Fall

u GSW

u Fight

u Crush injury

u Explosion
n Pneumothorax (tension too)
n Flail chest
n Hemothorax
n Sucking chest wound
n Traumatic asphyxia
n Pericardial tamponade
Terms

Asymmetrical chest wall movement that

lessens respiratory efficiency
Terms
 Terms
A dressing that can form an airtight seal
over a wound
 Terms

The difference between the systolic and

diastolic blood pressures. Narrowing seen
with pericardial tamponade.
 Terms

Presence of air in the subcutaneous tissue;

the resulting crackling sensation or sound
Tension Pneumothorax
page 945

n Build up of air and pressure in the thoracic

cavity of the injured lung is so severe that it
places pressure on the uninjured lung.
n Results in compression of the heart, large
vessels, and the uninjured lung.
n
BAD STUFF
BAD STUFF
QUESTIONS ?