Chapter 30: Chest Injuries
Overview
This chapter is from "Emergency Care and Transportation of the Sick and Injured, 12th Edition". This lecture covers the management of patients with chest trauma, recognizing life threats, and providing immediate intervention.
Key Topics
- Anatomy and physiology of the chest and underlying organs
- Pathophysiology and complications
- Assessment and management of chest injuries
- Age-related issues in pediatric and geriatric trauma
- Incidents leading to morbidity and mortality
- Blunt vs. penetrating and open trauma
Types of Chest Injuries
- Sucking chest wounds
- Pneumothorax
- Tension pneumothorax
- Hemothorax
- Flail chest
- Pericardial tamponade
Anatomy and Physiology
- Thoracic Cage: Extends from the lower neck to the diaphragm.
- Ventilation vs. Oxygenation: Ventilation is the movement of air; oxygenation is the delivery of oxygen in the blood.
- Intercostal Muscles: Aid in chest expansion during breathing.
- Pleura: Parietal pleura lines the chest wall; visceral pleura covers the lungs.
- Diaphragm: Separates thoracic and abdominal cavities, aids in breathing.
Mechanisms of Injury
- Blunt Trauma: Can fracture ribs, sternum, bruise lungs, and heart.
- Penetrating Trauma: Object penetrates the chest wall.
Signs and Symptoms of Chest Injuries
- Pain at the injury site
- Bruising, crepitus
- Dyspnea, tachypnea
- Cyanosis, diminished breath sounds
Patient Assessment
- Scene Size-Up: Ensure safety, determine mechanism of injury.
- Primary Assessment: Address life-threatening hemorrhage, airway and breathing, and circulation.
- Transport Decision: Rapid transport for airway, breathing, or circulation problems.
- History Taking: Investigate the mechanism of injury and obtain SAMPLE history.
- Secondary Assessment: Focus on physical examination and vital signs.
Management of Specific Injuries
- Pneumothorax: Accumulation of air in pleural space; treat with occlusive dressing.
- Tension Pneumothorax: Air pressure collapses lung; requires immediate transport.
- Hemothorax: Blood in pleural space; rapid transport is crucial.
- Cardiac Tamponade: Fluid in pericardial sac impairs heart function.
- Rib Fractures: Supplemental oxygen is essential.
- Flail Chest: Paradoxical movement of chest wall; requires careful monitoring and support.
Other Chest Injuries
- Pulmonary Contusion: Blood fills alveoli, causing hypoxia.
- Sternal and Clavicle Fractures: Risk of injury to lungs and great vessels.
- Traumatic Asphyxia: Severe compression, rapid increase in chest pressure.
- Commotio Cordis: Sudden blow during critical heartbeat phase causing cardiac arrest.
Review Questions
- Discussed aortic injuries, signs of chest injuries, and emergency interventions.
- Emphasized the importance of immediate actions for open chest wounds and pneumothorax.
Conclusion
The lecture concluded with a review of questions to test comprehension on chest injuries and encouraged more learning through subscription to the lecture series.