EMT-Chapter 34-Chest Trauma

The hollow area located in the thoracic cavity between the right and left lungs.

• Visceral pleura: innermost layer in contact with the lungs
• Parietal pleura: outermost layer in contact with the thoracic wall
• Between the pleural layers is a potential space.

• Air in the pleural space causing collapse of the lung
• A hole of the size of a nickle would be deadly.

• An open wound to the chest that permits air to enter into the thoracic cavity.
• Open chest injury.

• Severe buildup of air and pressure in the thoracic cavity.
• Air leaking in the chest cavity with no opening through the outer chest wall.
• Open chest injury.

• Two or more adjacent ribs that are fractured in two or more places and thus move independently from the rest of the rib cage.
• Displays paradoxical movement

A section of the chest that moves in the opposite direction to the rest of the chest during the process of respiration. Typically seen with a flail segment.

• Bleeding within the lung tissue that causes a disturbance in gas exchange between the alveoli and capillaries.
• Often the consequence of a flail segment.

An open wound to the chest that allows air to enter the pleural space and cause lung collapse.

• Blood in the pleural space, causing collapse of the lung.
• Filling the space with blood rather than air.
• Care is same for pneumothorax and shock.

• Severe and sudden compression of the thorax that causes a rapid increase in pressure within the chest.
• JVD

• A cardiac injury following severe blunt trauma to the chest where the heart is violently compressed between the sternum and spinal column, causing a bruise to the heart wall.
• Could lead to commotio cordis

Sudden cardiac arrest that results from a projectile, such as a baseball, striking the anterior chest.

• Blood or fluid filling the fibrous sac around the heart, causing compression of the heart.
• Usually results from cardiac contusion

• Quickly expose the chest and examine it.
• If a hole exists, immediately seal it with a gloved hand.
• If a shot or stab wound is suspected, log roll the patient to assess the posterior body for an exit wound.
• Look for subcutaneous ephysema (air trapped under the skin giving it a bubbly inflated appearance)

• Cyanosis
• Dyspnea
• Tachy/bradycardia
• Hemoptysis: Coughing up blood or blood-sustained sputum
• Signs of Shock
• Tracheal deviation
• Subcutaneous emphysema
• JVD
• Drop in systolic blood pressure of more than 10mm during inhalation

• 1. Immediately seal the wound with gloved hand
• 2. Apply an occlusive dressing to the seal the wound(taped on three sides)
• 3. CTSly assess the patient's breathing status:
• -Difficulty breathing
• -Tachypnea/dyspnea
• -Severely decreased or absent breath sounds in injured site
• 4. Flail segments should be splinted.