EAC Chest Injuries

Question 1

the two types of chest injury are:

Answer 1

Open

Closed

Question 2

causes of chest injury are:

Answer 2

Blunt trauma (20mins ONS) - a blow to the chest with a blunt object can damage ribs with/out damage to underlying organs

Penetrating trauma (5mins ONS) - bullets, knives, pieces of metal, timber, glass etc can penetrate the chest wall and damage underlying organs

Compression - a rapid compression of the chest from crush injuries e.g. impact from steering wheel. Slow compression can also cause injuries

Question 3

define chest injury

Answer 3

Trauma to the thoracic cavity leading to the impairment of respiratory function

Question 4

the categories of chest injury are:

Answer 4

Fractured ribs

Simple pneumothorax

Open pneumothorax

Tension pneumothorax

Haemothorax

Flail segment

Question 5

define:

Fractured Ribs

Answer 5

A broken rib, or fractured rib, is when one of the bones in your rib cage breaks or cracks

most common form of chest injury

Normally caused by blunt trauma

Commonly involves the 5th to 10th ribs

Question 6

define:

Simple/Spontaneous Pneumothorax

Answer 6

A simple pneumothorax is a non-expanding collection of air around the lung. The lung is collapsed, to a variable extent.

Occurs when air leaks out from a rupture in the lung tissue, which then seals itself off

severity of condition relates to amount of air in pleural cavity

Question 7

define:

Open Pneumothorax

Answer 7

Open pneumothorax is a pneumothorax involving an unsealed opening in the chest wall; when the opening is sufficiently large, respiratory mechanics are impaired.

Caused by penetrating trauma, allows air to be sucked into the pleural cavity during inspiration

Question 8

define:

Tension Pneumothorax

Answer 8

Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this ‘one-way-valve’ effect.

Air enters the pleural cavity through an open chest wound but cannot escape back out on exhalation due to a flap of tissue acting as a one-way valve. every time the pt inhales the intrathoracic pressure increases.

Question 9

define:

Haemothorax

Answer 9

Haemothorax is a collection of blood in the pleural space and may be caused by blunt or penetrating trauma.

Haemorrhaging into the pleural cavity due to damage to surrounding tissues.

Question 10

define:

Flail Segment

Answer 10

Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks under extreme stress and becomes detached from the rest of the chest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently.

When two or more ribs, and/or the sternum, are fractured in two or more places an unstable segment or flail chest occurs

Question 11

signs and symptoms of:

Fractured Ribs

Answer 11

Localised pain over injury site

Tenderness over injury site

Pain aggravated by deep breathing or coughing

Pt tries to remain still

Pt leans toward injured side

Pt holds fractured side while breathing

Question 12

signs and symptoms of:

Simple Pneumothorax

Answer 12

Sudden sharp pain

Dyspnoea

Hyper-resonance to percussion

Diminished breath sounds

Tachycardia

Question 13

signs and symptoms of:

Open Pneumothorax

Answer 13

Dyspnoea

Sharp pain on inhalation

Sucking sound through chest on inhalation

Diminished breath sounds

Hyper-resonance to percussion

Open chest wound

Soma air may bubble out of wound when pt exhales

Question 14

signs and symptoms of:

Tension Pneumothorax

Answer 14

Extreme dyspnoea

Shallow, rapid respiration

Cyanosis

Tachycardia

Diminishing breath sounds

Narrowing pulse pressure

Hyper-resonance to percussion

Distended neck veins

Tracheal deviation

Subcutaneous emphysema

Question 15

signs and symptoms of:

Flail Segment

Answer 15

Dyspnoea

Possible cyanosis

Paradoxical movement of the flail segment on injured side

Tachycardia

Question 16

define:

Paradoxical Breathing

Answer 16

Paradoxical breathing is a condition when your chest moves inward during inhalation instead of moving outward. This abnormal chest movement affects your breathing pattern and keeps you from inhaling enough oxygen.

Question 17

Examination of chest techniques:

Answer 17

Look - bi-lateral chest rise and fall, any obvious deformity, any bruising, any penetrating trauma wounds, any flail segment

Listen/auscultation - diminished breath sounds, sucking sounds, hyper-percussion, crepitus

Feel - any deformity, crepitus

Question 18

management of chest injuries

Answer 18

ensure an open airway

Administering high concentration O2

Considering assisted ventilations

Sealing any wounds, in the upper and lateral margins only, with an occlusive dressing

Making the patient comfortable, sitting semi-recumbent but inclined to the injured side

Percussion and auscultation of the chest wall

Place the arm on the injured side in a triangular sling to stabilise the chest wall

rapid and smooth transport to hospital

ALWAYS consider mechanism of injury and associated injuries. by doing so you can anticipate potentially life threatening problems.

Question 19

Patient positioning with chest injuries

Answer 19

Conscious: semi-recumbent or upright inclined to injured side.

Unconscious: recovery position with injured side lower to allow drainage of wound and lungs and to allow the good side to work effectively.

must consider mechanism of injury, which may suggest that a spinal injury exists in which cane you must treat accordingly - immobilise. keep supine if so.

Question 20

management of:

Flail Segment

Answer 20

Do not immobilise the injury

Maintain ventilation

Inclining pt to affected side can not be achieved on ortho/rescue board

Consider the need for analgesia

Time critical transfer appropriate to trauma tree

Question 21

management of:

Open Pneumothorax

Answer 21

Primary survey

Time critical correct A and B then go

Seal open wounds with chest-seal dressing (one each side one largest hole or the sucking hole. Then use nightingale dressing to seal any more)

100% O2. Ventilate if required

Pain management

Secondary survey en route

Immobilise fractures

Consider full immobilisation

Time critical transfer appropriate to trauma tree

Question 22

management of:

Tension Pneumothorax

Answer 22

Ensure pt airway

Assess breathing adequacy - rate, volume, equality

High % O2

Feel, look and auscultate

Requires needle thoracentesis - paramedic

Pain management

Time critical transfer appropriate to trauma tree

Question 23

potential damage to organs from chest injury

Answer 23

Pulmonary contusion - bruised lung/s

Myocardial contusion - bruised heart

Cardiac tamponade - blood in pericardial sack

Traumatic asphyxia - back flow of de-oxygenated blood through veins

Question 24

signs and symptoms:

Cardiac Tamponade

Answer 24

Signs of hypovolemic shock

Tachycardia

Signs of blunt or penetrating trauma

Becks triad:

• hypotension
• distended neck veins
• muffled heart sounds

REQUIRES time critical transfer

Question 25

management of:

Cardiac Tamponade

Answer 25

blunt trauma to the sternum may induce myocardial contusion and may result in rhythm changes.

ECG monitoring

High % O2

pain management

Time critical transfer appropriate to trauma tree

Question 26

consideration for chest injuries to:

Children

Answer 26

Proportionally smaller then adults

Smaller lung capacity

Relatively minor injuries are often fatal

Question 27

consideration for chest injuries to:

Elderly

Answer 27

Often have under-lying chest conditions

Brittle bones

Less resilient

Question 28

Chest injury

Key Points

Answer 28

Thoracic injury is commonly associated with hypoxia either from impaired ventilation or hypovolaemia

Count RR and look for asymmetrical movement

Pulse oximetry MUST BE used - hypoxia recognition

Mechanism of injury is an important guide

Blunt trauma to the sternum may induce myocardial contusion and may result in ECG rhythm changes

ECG monitoring

Impaled objects should be secured, if pulsating allow object to pulsate

Do not probe or explore penetrating injuries