Ch. 3 - Chest Injuries Flashcards
True or False. NOLS Incident Data shows rib fractures are the most common chest injuries in a wilderness context?
True!
However, Accidents in North American Climbing also show quite a few serious chest/lung injuries from falls.
What is the repertory rate for a healthy adult?
12-20 breaths per minute
What are the signs and symptoms of a Rib Fracture?
Deformity/Discoloration over the injured area.
“Point Tenderness” - Tender to the touch over fracture.
Sharp/Stabbing pain.
Breaths become shallow when dealing with pain.
May clutch to the chest to stabilize.
What are treatments for a Rib Fracture?
A single rib usually doesn’t require splinting. Pain medication may be all that is required.
If patient is in pain, try taping the chest from sternum to spine on the injured side to decrease movement and pain. Never tape around whole chest.
Sling and Swath will help too.
Under what circumstances should we evacuate for a Rib Fracture?
If there is shortness of breath after an injury to the rib area they need to be evacuated.
However, if it is a simple fracture with no shortness of breath they may be able to walk out and not need emergency evacuation.
What is Flail Chest?
An unstable chest wall caused by 3 or more adjacent ribs being broken in two or more places.
What are signs and symptoms of Flail Chest?
- Paradoxical Respirations (When you inhale the injured side will not expand, but it will upon exhale when chest contracts).
- Repertory Distress
How would we treat Flail Chest?
Stabilize the chest:
- Place the patient in the most comfortable position to breathe. Could be on the injured side with a rolled up piece of clothing against the unstable segment.
- Tape a large pad/bulky dressing firmly over the unstable segment with out circling the whole chest with tape.
- Treat for Shock and Evacuate!
What is a pneumothorax?
When air leaks into the pleural space it can collapse the lung.
Traumatic Pneumothorax = A fractured rib that lacerates the lung.
Spontaneous Pneumothorax = A weak spot on the lung wall that gives in.
Open Pneumothorax = Open Chest Wound
What is a Spontaneous Pneumothorax?
A weak area of the lung that may rupture. Occurs in tall, thin men between 20-30 years of age.
80% occur when at rest, patient suddenly complains of sharp pain in chest and increasing shortness of breath.
What is a Tension Pneumothorax?
The hole in the pleural space acts as a one-way valve. As pressure increases the lung collapses and pushes on heart on the uninjured side.
As pressure builds could deviate the Trachea toward uninjured side. Tissues between ribs bulge and neck veins distend.
What is a Hemothorax?
When lacerated blood vessels leak blood into the pleural space rather than air. The source could be a fractured rib or lacerated lung. If more than 1 liter leaks in it can compress the lung. Hypovolemic Shock expected.
How do we treat an Open Chest Wound?
Limit the size of the Pneumothorax!
- Use a commercial chest seal
- Occlusive dressing like a plastic bag or petroleum jelly-impregnated gauze.
- Tape on 4 sides and let the patient stop to drain fluid when necessary.
