Chest Injuries

  1. What can get injured
    • Heart
    • Blood Vessels
    • Lungs
    • Airways
    • soft tissue
    • Bones
    • Spinal Cord
    • Nerves
    • Remember front back sides of chest for injuries
    • arteries in mediastinum
    • vagus nerve - parasympathetic, diggestive system, lungs, heart
    • frenic nerve - diaphragm  75% of breathing is via Diaphragm
  2. Force
    Mass x Acceleration
  3. What can get injured
    • Remember Diaphragm ..where was it Splits Thoracic and Abdo
    • Liver
    • kidneys
    • spleen
    • stomach pancreas gall bladder
    • any neck injury
  4. MOI
    • Blunt or Penetrating 
    • Force delivered
    • Duration ( Repeated stabbing)
    • Direction ( angles) 
    • Crush or Compression
  5. Consider
    • Being Stabbed
    • Shot
    • Driver of a car hitting a wall at speed
    • Being kicked punched hit with an object
    • Falling onto something 
    • Elderly/children
  6. Assesment
    • Primary Survey - D R C A (C) B C D E
    • is there an issue with Airway,breathing, circulation, disability. Some Major chest injuries will fail at B - if you cant correct load and go.
    • Expose the chest
    • count RR, capnography
  7. Secondary Survey
    • Done on Route if time allows 
    • Head to toe exam , cut clothing 
    • ECG
    • Auscultate all lung fields
    • Auscultate heart sounds ( 5th Intercostal space on left) 
    • Pain score 
    • Review MOI again
    • PMHx ( past medical History)
  8. Assesment of Chest/Abdo
    • I - Inspect
    • P - Percuss
    • P - Palpate
    • A - Auscultate
  9. Twelve - Assessing chest/neck injuries
    • T - Tracheal Deviation
    • W - wounds, brusing or swelling
    • E - emphysema ( surgical) 
    • L - Laryngeal Crepitus 
    • V - Venous Engoregement 
    • E - Excluding open/tension Pneumothorax, flail segment, haemothorax
  10. Chest injuries Signs and Symptoms
    • Deformity, swelling, bruising, wounds
    • Dyspnoea
    • Tachypneoa/Bradypneoa
    • Short of Breath
    • Shallow Resps
    • increased effort fo Breathing ( Use of Intercostal muscles) 
    • Abnormal Chest wall movement 
    • surgical emphysema - crackeling under skin
    • abnormal/reduced breath sounds
    • Pain/tenderness 
    • Blood loss
    • Signs of clinical shock
    • Anxiety 
    • reduced LOC
  11. Treatment
    • Oxygen (Titrate 94-98%)
    • Wound Dressing 
    • Analgesia ( entonox and Paramedic morphene etc) 
    • Assist ventilations
    • patient position
    • Paramedic intervention 
    • Time Critical transfer
  12. Flail Chest
    • 2 or more ribs fractured in 2 or more places
    • Usually from blunt trauma 
    • May see Paradoxical ( uneven) chest wall movement 
    • Bruised lung 
    • Hypoxia
  13. Fractured Sternum
    • Will indicate significant probability of other injuries
    • strong bones, requires lots fo force to fracture
    • More than 25% of PTS with a fractured sternum will die
  14. Pneumothorax
    • Air in thoracic cavity ( pleural space) 
    • Can be spontaneous 
    • Can be caused by blunt or penetrating trauma
  15. Pneumothorax
    • if more air is able to occupy the thoracic cavity it can put pressure on the lung causing it to collapse 
    • Eventually it can cause other structures to shift away from the pressure ie tracheal deviation 
    • Can put Pressure on the blood vessels returning blood to the heart and to the heart itself causing obstructive shock
  16. Open Pneumothorax
    • Occurs from Penetrating trauma
    • Thoracic pressure changes with each inspiration air is drawn into the pleural space via the wound resulting in a sucking chest wound
    • If wound is large enough air will enter via the  wound rather than trachea, putting PT at risk of more Hypoxia
  17. Tension Pneumothorax
    • Life Threatening Emergency 
    • air Enters the Thoracic cavity ( pleural cavity)  and cant escape 
    • can occur from penetrating trauma, blunt trauma ie broken rib , crushing injury, blast wave etc. eg blowing a balloon until it bursts
    • PT will become Dyspnoeic, tachycardic, hypotensive
    • You may notice: reduced chest wall movement, reduced breath sounds, distended neck veins, tracheal deviation. 
    • Paramedic required for needle chest  decompression
  18. Haemothorax
    • Blood in the Pleural cavity
    • Occurs from penetrating trauma 
    • Blood takes up space where normally occupied by the the lungs and they collapse 
    • Patient will be hypoxic and Hypovalemic
  19. Cardiac Tamponade
    • Excessive fluid in the pericardial sac compresses the heart limiting its ability to pump
    • common in penetrating injury 
    • only requires 20-30ml of blood to cause tamponade - check MOI
    • can cause Obstructive and cardiogenic shock
  20. Cardiac Tamponade Signs
    • MOI - Penetrating wound to heart
    • Clinical Shock ( obstructive/cardiogenic) 
    • Distended neck Veins
    • Reduced LOC
    • HEMS required for Possible Thoracotomy
Author
Davef
ID
345532
Card Set
Chest Injuries
Description
Chest Injuries
Updated