welcome back everybody today's video is a continuation of our general trauma management videos so our bleeding control tension pneumothorax that kind of thing and today we're going to be discussing chest trauma how to recognize it and how to treat it [Music] [Music] all right before we get into the meat of the video a quick channel update for you guys I've got a lot of great stuff coming up down the road I'm actually fortunate enough to have a company reach out to me and offer to send me a couple eye facts to be reviewed on the channel and then also a couple extra to be given away to you guys so in the next couple weeks we'll be doing a giveaway stay tuned for that I'll be announcing it a little bit earlier on my Instagram but it will also come up on YouTube and I'll tell you how to enter in all of that good stuff next week I'm gonna be going to a swot school so I'm gonna try to get a video while I'm there I don't know what the topic will be yet but I do have to be kind of tactful because I'm there mainly to learn for myself and a lot of the guys at these classes don't really enjoy being filmed a whole lot so it kind of remains to be seen if I'll be able to produce a video or not I need to be respectful of their wishes so we'll see if I don't come out with video next week that's why but I will make a solid effort to get something to you guys so jumping into the video today's video like I said before is all about thoracic trauma so chest trauma how to recognize and treat it we're gonna be talking about three main types of chest trauma the first is blunt trauma penetrating trauma and then in kind of a subcategory of penetrating trauma we'll talk about how to deal with impaled objects so the first category we're in discuss is your blunt-force trauma this is you'll falling out of a car getting hit something like that where there's a force exerted on your chest but you don't have anything that's actually penetrating the chest wall this can result in any number of internal injuries that we need to be aware of in the pre-hospital setting unfortunately there's not a whole lot we can do for these patients the outside of an operating room one of the first lessons any EMT or paramedic student learns is that trauma is not fixed in the field it's fixed in the hospital so keep that in mind as we go forward if you have somebody that's experienced blunt force trauma you're going to assess them in a couple ways first you're going to take your hand and you're gonna blade it right on the sternum to make sure that's stable and then you can come around on their chest wall and palpate around their chest come to the side and have them take a deep breath what you're looking for in these cases is broken ribs so crepitus if you do that and you feel something shift or you feel something when they breathe in that's not equal that's a big indication of blunt force trauma also you're going to be looking for signs of a pneumothorax so you want to listen to both sides of the lungs make sure that they're equal you're gonna be looking for Hyper residents or motion that's not equal on either side of the chest they take a breath one side goes up the other one does not additionally pain of the patient is a good indicator that there's underlying trauma so there are a couple main injuries that can occur from this and we'll talk about the management of each the first one and the one that we're probably most concerned about is going to be a tension pneumothorax and I discussed that in another video the in-depth treatment of that is there if you want to take a look at it but a tension pneumothorax is a collapsed lung and that can be caused in blunt force trauma if you have what's called Barrow trauma so huge increase in pressure on the inside of the lung from that force or it can be caused by a rib fracture that's displaced inwards that actually punctures the lung and causes that to collapse the other thing we're looking for our major rib fractures so if you have three or more ribs in a row that are fractured in two spots each you can get what's called a flail segment and this is a section of ribs that won't actually go in and out when the patient takes a deep breath and this is a big problem so management tension pneumothorax obviously we're going to do a needle decompression on the affected side and relieve that pressure now if it's broken ribs unfortunately there's not a whole lot we can do for them back in the emergency days if you ever watch that show they would take a cinder block put it on the chest to keep that segment in place even when I went to school about seven years ago we would take a big bulky dressing tie it really tight and to try to get that flail segment to hold still now we're not doing any of that basically you're going to be doing supportive measures keep them in the position of comfort give them supplemental oxygen if they're saturating kind of low and you might have to do rescue breathing for them if they're not able to take those deep breaths be aware if you're gonna do rescue breathing that that actually increases the chances of attention pneumothorax so I'm not saying not to do it but just be aware that's a potential complication and make sure you're monitoring the patient constantly for the formation of a tension pneumothorax so for this type of injury you your goal should be to get them to a hospital as soon as possible and that's going to maximize their chances of survival the second type of trauma that we're going to discuss is penetrating trauma so penetrating trauma is your stab wound or your gunshot wound or even just a random object that impaled the patient so this kind of trauma can cause what's called a sucking chest wound and I'm not going to go too in depth in the physics of respiration but essentially when you take a deep breath in your diaphragm is actually contracting down and that's causing negative pressure in your chest and causing your lungs to fill with air now if you do that and you've got a hole that's equal size or larger than your trachea instead of it coming through there coming through your mouth it's actually going to be sucked into the hole in the chest and that's going to cause the lung to collapse obviously you don't have any of Eli on the outside of your lung which is what actually transfers the gases so they're going to be breathing into their thoracic cavity and there's not going to be any oxygenation happening luckily for us this is pretty easy to treat now I'm going to preface this next part by saying I usually do these medical videos inside the hospital where I have access to mannequins and a lot of training supplies I don't have any of those at home so in today's video we're gonna be pretending that this box is someone's chest and we're going to be demonstrating on this so let's say you have penetrating trauma now this is a sucking chest wound and we need to treat this it's going to be bleeding a little bit but my biggest concern with this is that I don't want air to get into this or I can't just put a gauze pad over that because those are permeable so it will actually suck air through the dressing so in this case we have to get what's called an occlusive dressing this is a trainer - chest seal from North American rescue it doesn't matter what brand you get you know this is what we use so this is what I have and what these are is these are plastic dressings that have some vents in them that can go over these wounds and create kind of an artificial skin to keep any air from coming in to that the vent also allows air out to expel whatever error was in that cavity when you put it on and keep anything from coming back so to apply this it's pretty simple you want to peel it off the protective cover you're going to take it and you're just going to stick it right over the wound you want the wound kinda centered right here so that the valve can actually be used but there's really nothing to it so this is gonna be your general management now you're not really going to be supe concerned about controlling bleeding because any bleeding is going to be way internal and there's really no way to stop that in the pre-hospital setting which brings us back to getting the patients to the emergency room and essentially the operating room as soon as possible be aware with any kind of penetrating trauma that there may be an exit wound so if you have somebody that shot you can treat the stuff on the front but make sure you're doing a good blood sweep and a visual inspection of the back to ensure there's not a through-and-through if there's a through-and-through treated the same way just take a second chest seal put it on the back that's one of the reasons I like the hyphens is you can get them in a twin pack so you always have two on you to do both an entrance and an exit wound be aware that once you put this on the patients at an increased risk of developing a tension pneumothorax so monitor them constantly if that occurs all you have to do is take the edge of this and burp that wound and that will release whatever air is trapped now in some cases that might not work or in other cases you might only take this off because there's a lot of blood and gore and the adhesives won't stick back onto the patient in those cases just take your needle decompression and do a decompression on that patient if you're trained to do so if not try burping it and go from there last and final piece of trauma that we're going to talk about is your impaled objects so going back to our little simulated chest if you have somebody that say was stabbed and they have an impaled object in their chest we do not want to remove this so when somebody stabbed this is severing a lot of arteries and veins and this is actually acting as a pressure dressing at the same time because it just severed those arteries it's going to be up against that and it might be including some bleeding so if you pull this out they can bleed to death and die Steve Irwin probably still would be alive today if they had left the stingray barb in his heart because as soon as they pulled that up it opened the floodgates and he bled out internally so never ever removed and remove an impaled object there are some it's got exceptions but we'll talk about that right at the end here so how do we treat this well we do not want this knife sitting here doing this making mincemeat of the internal organs so we want to stabilize this as best we can and this is one of those situations where your critical thinking skills are going to come into play because it doesn't really matter how you stabilize this all it matters is that this is stabilized and kept from moving anywhere probably the most common way to do it is you take some bulky dressings and you can put them on either side of the object and then tape around it and that's going to hold it still keep it from moving around keep it from coming out or going any deeper in then you can take tape or other kravitz and wrap around the patient and secure that in place obviously other supportive measures like oxygen therapy and bag-valve-mask respirations are going to come into play here but this is how you stabilize the object itself now there are two main reasons why you would have to remove an impaled object the first reason is if that impaled object is going to interfere with CPR so if the patient's dead and you're going to attempt resuscitation on them and say I think the EMS like example they give is always an axe buried in the sternum so if you have that they're in cardiac arrest you can remove that axe to do CPR because although that might cause more harm you're not they're already dead so you're not going to do any more damage and you might give them a chance at life the second reason you might remove an object is if it is actively causing an airway obstruction airway breathing circulation our three biggest concerns and if they don't have an airway it doesn't matter how good your care is they're going to die so you have if say they've got a knife that's in the trachea that's blocking that airway you can pull that out and that's not to say that that's not gonna cause issues down the road but it's what you have to do in that situation so a quick recap here for you guys if the patient has a blunt force trauma it's going to be supportive measures only so give them oxygen breathe for them if you have to and manage pain as best you can if it is a penetrating trauma so gunshot wound knife wound something like that we're going to taking occlusive dressing and put it over the wound make sure you're looking for both an entrance and an exit wound on these patients and then the third type of trauma is going to be your impaled object if they have an impaled object do not remove that object stabilize it in place and get to the hospital as soon as possible you can remove those objects if CPR has to be performed and it's interfering or if it's an active airway obstruction if you have any questions about this video or anything I talked about today please leave them in the comments down below I really enjoy hearing from you guys I'm really excited that this channel has grown so much over the past several months I go starting this about six months ago was to get to a thousand subscribers by the end of the year and we're all at almost 20,000 so my expectations have absolutely been blown out of water and I'm very thankful to all of you like always thanks for watching and I will see you next week [Music] [Music] [Applause]