EMT-Chapter 34-Chest Trauma
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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.
Sucking Chest Wound
- 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.
- 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)
Signs and Symptoms
- Hemoptysis: Coughing up blood or blood-sustained sputum
- Signs of Shock
- Tracheal deviation
- Subcutaneous emphysema
- Drop in systolic blood pressure of more than 10mm during inhalation
Emergency Care to an Open Chest Wound
- 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
- -Severely decreased or absent breath sounds in injured site
- 4. Flail segments should be splinted.
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