Trauma

• Feel (chest walls for sweeling, deformity)
• Look (for subtle changes)
• Auscultate (Lateral chest and anterior armpit)
• Percuss
• Search (for wounds and blood/fractures)

• Tracheal elevation
• Wounds
• Emphysema (under the skin)
• Laryngeal crepitus
• Venous engorgement
• Exclude: Pneumothorax, Haemothorax, Flail Chest.

• Situation (me, P/C, any concerns)
• Background (HxPC, MHx, DHx, SFHx)
• Assessment (Obs, O/E)
• Recommendations (include requests and read-back)

• Call sign
• Age
• Time of injury
• MOI
• Injury found
• Signs (vital signs)
• Treatment given

Heart, blood vessels, lungs, airways, soft tissue, bones, spinal cord, liver, kidneys, spleen.

• Expose the chest!
• Basic obs - RR, SPO2.
• Look for wounds
• Look for symmetrical breathing
• Look at the neck
• Listen to the lungs
• Feel for any deformities or swelling

• Deformity, bruising, swelling.
• Resp rate - lack of, fast, slow.
• SOB
• Shallow respirations.
• Use of accessory muscles
• Emphysema under skin.
• Pain
• Signs of clinical shock.
• Anxiety
• LOC

• Oxygen
• Wound dressings - consider Russell Chest Seal and Nightingale Dressing.
• Analgesia
• Assist ventilations
• Position patient
• Paramedic intervention?

• Inadequate breathing.
• Blood loss.
• Damage to soft tissue including lungs, leading to secondary injury.

• Indicates SIGNIFICANT chance of other major injuries.
• The force required to break it means other organs or bones may be injured.
• Time critical.

• Paradoxical chest movment
• Two or more ribs broken in two or more places.
• Likelihood of lung injury or bruising.

• Air in the pleural cavity.
• Can be life threatening.
• Puts pressure on the lung causing it to collapse. 
• Eventually causes other structures to displace (eg trachea).
• Puts pressure on blood vessels returning blood to the heart, and becomes an obstructive shock. 
• Open pneumothorax - can see a sucking wound as thoracic pressure changes and air is drawn into the pleural space. 
• Hypoxia 
• Tension pneumothorax - air enters the pleural cavity but cannot escape, occupying space (as above)

• Blood in the pleural cavity.
• Usually from penetrating trauma injuring major blood vessels. Can be from blunt trauma which shears.
• Blood fills the pleural cavity and takes up space usually occupied by lungs and they collapse. 
• Hypoxia
• Hypovolaemia.

• Excessive fluid in the pericardial sac, compresses the heart, limiting it's ability to pump.
• Usually a penetrating wound to the heart.
• Clinical shock is a result.
• Distended veins.
• LOC.

• High-energy transfer from RTCs, falls from height, crushing.  
• Also can be pathogenic - in the elderly with osteoporosis, or receiving radiotherapy.

• MOI.
• Increased risk of haemorrhage.
• Urogenital injuries.
• Often accompanied by other injuries.
• Bleeding
• Bruising
• Deformity / swelling
• Shortening of lower limb
• Pain over hips, groin, sacrum.
• Hypovolaemic shock.
• Frogs Legs.

• c-Spine
• Control catastrophic haemorrhage.
• High flow O2.
• Pelvic splint (with log roll).
• Analgesia.
• Paramedic assistance.
• Swift transfer to MTC.
• Avoid repeated movement.
• Do not spring the pelvis.