Chapter 31: Chest and Abdominal Trauma

Review of Chest and Abdominal Cavities

Extends from collar bones to diaphragm
Diaphragm in motion allows expansion and contraction
Contains organs, major blood vessels, lung tissue
- 12 sets of ribs, sternum, thoracic spine vertebrae, scapula create protective cage
Functions: heartbeat, blood flow, respiration
- Inhalation (active) uses negative pressure for air intake
- Exhalation (passive) uses positive pressure for air release

Divided by diaphragm from chest, includes into pelvis
Contains 4 quadrants:
- Solid Organs: Spleen, liver, pancreas, kidneys (blood-rich, prone to bleeding)
- Hollow Organs: Stomach, gallbladder, intestines, bladder (fluids can cause severe damage)
Potential Issues: Bleeding, foreign substances in the cavity
- Solid organs: rupture easily, severe bleeding
- Hollow organs: tolerate trauma unless rapid pressure change

Concerns: Breathing disruption, organ damage, infection
Blunt force trauma: rib fractures (may cause internal damage), sternum damage, costal cartilage injury
Penetrating trauma: knives, bullets, objects causing internal damage
Compression/shearing injuries: rapid deceleration, body/organ inertia

Rib fractures: Cause pain, breathing difficulty, risk of further damage
- Multiple fractures: can lead to paradoxical motion (flail chest)
- Treatment:
  - Call ALS, support with tape, oxygen, position for comfort
  - Avoid restricting chest movement
Penetrating chest injuries: Life-threatening, assess and cover wounds
- Use occlusive dressing with a flutter valve
- Listening to lung sounds, monitor for shock

Pneumothorax & Tension Pneumothorax:
- Air in chest cavity, prevents lung expansion
- Tension Pneumothorax: Pressure compresses heart/lungs
- Assessment: Difficulty breathing, shock, distended jugular veins, tracheal deviation
- Treatment: ALS for needle decompression or thoracotomy, oxygen
Hemothorax: Blood in the chest cavity
Traumatic Asphyxia: Sudden chest compression, blood backed into head/neck
- Petechial hemorrhage, distended veins, cyanosis
Cardiac Tamponade: Blood in pericardium, pressure on heart limits activity
- Narrow pulse pressure, distended jugular veins
Aortic Injuries: Tearing/shearing of the aorta
- Pain, pulse/blood pressure differences, potential rapid fatality
Commodio Cordis: Sudden blow causes cardiac arrest, requires immediate defibrillation

Ensure ABCs (Airway, Breathing, Circulation)
Position of comfort, control bleeding, prepare for transport
Specific measures for identifiable conditions (taping ribs, occlusive dressings, etc.)

Open/closed injuries: Internal bleeding risk
- Evisceration: Organ protrusion, keep moist and covered, not pushed back in
- Blunt force trauma: Hard to diagnose, look for signs of internal distress
- Diaphragm rupture: Abdominal organs in chest, breathing difficulty
Gunshot wounds: May cause unpredictable internal damage
General Treatment:
- Knees flexed position, nothing by mouth, moist dressing for eviscerations
- Do not remove impaled objects, stabilize for transport

Questions and Discussion: