Chapter 30: Chest Injuries - Emergency Care and Transportation of the Sick and Injured, 12th Edition

Overview

• Focuses on management of patients with chest trauma.
• Recognizes life threats and immediate intervention techniques.
• Discusses anatomy, physiology, pathophysiology, assessment, and management.
• Includes age-related issues, morbidity, mortality, blunt vs penetrating trauma, and specific injuries.

Anatomy and Physiology of the Chest

• Chest Structure: Thoracic cage extends from the neck to the diaphragm.
• Key Components: Heart, lungs, great vessels.
• Pleura: Covers lungs and thoracic cavity.
• Muscles: Intercostal muscles between ribs, diaphragm separates thoracic and abdominal cavities.

Mechanics of Ventilation

• Inhalation: Intercostal muscles and diaphragm contract, creating negative pressure.
• Exhalation: Muscles relax, air is exhaled.
• Spinal Injuries: Affect breathing, particularly injuries below C5.

Types of Chest Injuries

• Closed Injuries: Skin isn't broken; often from blunt trauma causing contusions or fractures.
• Open Injuries: Penetrating wounds; manage impaled objects carefully.

Assessment and Management

• Scene Size-up: Ensure safety, identify number of patients, consider spinal stabilization.
• Primary Assessment: Focus on airway, breathing, circulation.
• Transport Decision: Prioritize patients with airway, breathing, or circulation issues.
• History Taking: Investigate mechanism of injury, obtain SAMPLE history.
• Secondary Assessment: Detailed physical exam, assess vital signs frequently.

Specific Injuries and Conditions

• Pneumothorax: Air in pleural space causing lung collapse.

  • Open Pneumothorax: "Sucking chest wound"; seal with occlusive dressing.
  • Simple Pneumothorax: Result of blunt trauma; manage with high-flow oxygen.
  • Tension Pneumothorax: Ongoing air accumulation; requires advanced intervention.

• Hemothorax: Blood in pleural space.

  • Hemopneumothorax: Combination of air and blood.

• Cardiac Tamponade: Blood in pericardial sac compresses heart.

  • Signs: Beck's triad (JVD, narrowing pulse pressure, muffled heart tones).

• Rib Fractures: Painful, can lead to further injury (e.g., pneumothorax).

• Flail Chest: Segment of chest wall detaches; paradoxical motion.

• Pulmonary Contusion: Alveoli fill with blood; leads to hypoxia.

• Commotio Cordis: Sudden impact to chest during heartbeat causes cardiac arrest.

• Laceration of Great Vessels: Can cause rapid, fatal bleeding.

Complications

• Over Ventilation: Can impair lung function, increase intrathoracic pressure.
• Traumatic Asphyxia: Severe chest compression increases chest pressure.

Treatment Priorities

• Rapid assessment and management of breathing, bleeding, and circulation.
• Transport without delay for advanced treatments.
• Use of supplemental oxygen and monitoring for signs of deterioration.

Review Questions

• Key injuries such as aortic shearing, paradoxical motion in flail chest, and signs of specific conditions like cardiac tamponade and traumatic asphyxia.