Chest Trauma First Aid
- Chest injuries are the second leading cause of trauma deaths each year.
- Chest injuries often go unrecognized.
- Missed injuries result in inadequate ventilation, hypoxia and hypercarbia.
- Our goal is to find these injuries early and treat them aggressively.
- Although blunt chest trauma is more common, it is often difficult to identify the extent of the damage because the symptoms may be generalized and vague.
- In addition, patients may not seek immediate medical attention, which may complicate the management.
Assessment of Chest Trauma
- The initial assessment should serve to detect most major chest injuries.
- The kinematics of the event will point to most major chest trauma.
- Pain from chest trauma tends to be provoked by deep inspiration and/or firm palpation.
- Observation: What are we looking for? Asymmetry, bruising, chest movements, obvious wounds, bleeding
- Palpation: What are we feeling for? crackles, irregular masses/ pieces of bone
- Auscultation: What are we listening for? Abnormal breath sounds
Categories of Chest Trauma
- Nonpenetrating Chest Injuries Causes
Blunt chest injuries are usually the result of deceleration in;
- Motor vehicle accidents
- Falls from heights
- Falling object
- Penetrating Chest Injuries Causes
Missiles such as;
- Arrows, Spears
- Penetrating wounds have only a site of entry. Perforating wounds have both an entry site and an exit site.
Types of Nonpenetrating Chest Traumas
- Rib Fractures
- Pulmonary Contusion
- Cardiac Contusion
Types of Penetrating Chest Traumas
- Aortic Tears
- Vena Cava Tears
Injuries to the chest are often life threatening and result in one or more of the following pathologic mechanisms:
- Hypoxemia from disruption of the airway; injury to the lung parenchyma, rib cage, and respiratory musculature; massive hemorrhage; collapsed lung; and pneumothorax
- Hypovolemia from massive blood loss from the great vessels, cardiac rupture, or hemothorax Cardiac failure from cardiac tamponade and cardiac contusion
- These mechanisms frequently result in impaired ventilation and perfusion leading to Acute Respiratory Failure, hypovolemic shock, and death.
Signs and Symptoms of Chest Trauma
- Chest Wall Bruising
- Chest Pain
- Asymmetrical Chest Wall Movement
- Rapid, Weak Pulse
- Trachea Deviation
- Distended Neck Veins
- Bloodshot or Bulging Eyes
Emergency Medical Treatment for Chest Trauma
- Examine Patient Airway
- Assess S&S of Respiratory Distress
- Administer O2 & Continuous O2 sat monitoring
- Check Vital Signs & Assess for shock
- IV access x 2
- Check for Bleeding, GXM of blood
- Remove clothes, Assess for other injuries
- Seal open chest wound with a 3-sided air occlusive dressing
- Do not remove impaled object(s)
- Rate and Depth
- Lung Sounds
- Chest Movement
- Trachea Deviation
- Respiratory Stridor
- Accessory Muscle Use
- Intercostal Muscle Use
- Subcutaneous Emphysema