Chapter 30: Chest Injuries

Introduction

• Chest injuries frequently encountered by emergency medical technicians.
• Over 1.2 million emergency visits annually in the U.S. due to chest trauma.
• Serious injuries can affect the heart, lungs, and great blood vessels.
• Causes include:
  • Blunt trauma (e.g., motor vehicle crashes, falls).
  • Penetrating trauma (e.g., shootings, stabbings).
• Immediate treatment is essential to prevent permanent damage.
• Internal bleeding and accumulation of air in the chest can compress organs.
• Quick action can be life-saving.

Anatomy and Physiology

Overview of the Chest

• Importance of understanding chest anatomy and respiration for evaluating injuries.
• Ventilation vs Oxygenation:
  • Ventilation: Movement of air in and out of lungs.
  • Oxygenation: Oxygen delivery to blood from alveoli.
• The thoracic cage protects vital organs and aids in ventilation.

Mechanics of Ventilation

• Inhalation involves contraction of intercostal muscles and diaphragm.
• Exhalation is a passive process of muscle relaxation.
• Phrenic Nerves: C3-C5, crucial for diaphragm movement.
• Minute ventilation: Tidal volume x breaths per minute.

Types of Chest Injuries

Closed Chest Injury

• Caused by blunt trauma.
• Can lead to pulmonary and cardiac contusions.
• Risk of rib fractures and potential internal bleeding.

Open Chest Injury

• Caused by penetrating trauma.
• Risk of pneumothorax and impaled objects.
• Removal of impaled objects should be done surgically.

Signs and Symptoms of Chest Injury

• Pain, especially with breathing.
• Bruising, crepitus, and penetrating injuries.
• Difficulty breathing and hemoptysis.
• Cyanosis and abnormal chest movement.
• Rapid, weak pulse and low blood pressure.

Patient Assessment

Scene Size-Up

• Ensure scene safety and call for backup if needed.
• Look for indicators of mechanism of injury.
• Consider spinal stabilization.

Primary Assessment

• Identify life threats and prioritize care.
• Ensure airway patency and assess breathing.
• Check for symmetric chest expansion.
• Manage life-threatening conditions like open chest wounds.

Secondary Assessment

• Focus on injury site and related systems.
• Re-evaluate vital signs and watch for changes.
• Assess for paradoxical motion and other abnormalities.

Common Chest Injuries

Pneumothorax

• Air in pleural space causing lung collapse.
• Symptoms: Dyspnea, diminished breath sounds, cyanosis.
• Treatment includes sealing the wound and providing oxygen.

Hemothorax

• Blood in pleural space compressing lungs.
• Suspect with signs of shock and reduced breath sounds.
• Requires surgical intervention.

Cardiac Tamponade

• Blood/fluid in pericardial sac impeding heart expansion.
• Signs: Jugular vein distension, muffled heart sounds, narrow pulse pressure.
• Requires recognition and supportive care.

Additional Chest Conditions

Rib Fractures

• Common in the elderly.
• Painful and may cause shallow breathing.
• Risk of pneumothorax if ribs penetrate pleural space.

Flail Chest

• Multiple adjacent rib fractures causing paradoxical motion.
• Treatment includes respiratory support and monitoring for complications.

Blunt Myocardial Injury

• Heart injury from blunt trauma affecting blood pressure maintenance.
• May mimic heart attack symptoms.

Commotio Cordis

• Sudden blow to the chest causing cardiac arrest.
• Early defibrillation and CPR are critical.

Laceration of Great Vessels

• Potentially fatal hemorrhage from injuries to major chest vessels.
• Immediate transport to trauma center necessary.

Summary

• Chest injuries require swift assessment and treatment.
• A detailed understanding of anatomy and symptoms aids in effective management.
• Transport to appropriate care facilities is often critical for survival.