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
  • Assault.
  • Penetrating Chest Injuries Causes

  Missiles such as;

  • Firearms
  • Knives 
  • 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
  • Pneumothorax
  • Pulmonary Contusion
  • Cardiac Contusion

Types of Penetrating Chest Traumas

  • Pneumothorax
  • Aortic Tears
  • Vena Cava Tears

Pathophysiology

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
  • Dyspnea
  • Cough
  • Asymmetrical Chest Wall Movement
  • Cyanosis
  • Rapid, Weak Pulse
  • Hypotension
  • 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)

Respiratory Assessment

  • Rate and Depth
  • Lung Sounds
  • Chest Movement
  • Cyanosis
  • Trachea Deviation
  • Respiratory Stridor
  • Accessory Muscle Use
  • Intercostal Muscle Use
  • Subcutaneous Emphysema
  • ABGs

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