Chapter 30: Chest Injuries

Introduction

• EMTs frequently encounter chest injuries.
• Over 1.2 million emergency visits in the US due to chest trauma annually.
• Heart, lungs, and great vessels are located in the chest, making injuries potentially serious.
• Types of trauma:
  • Blunt trauma: motor vehicle crashes, falls.
  • Penetrating trauma: shootings, stabbings, industrial incidents.
• Immediate treatment is critical to prevent permanent damage.
• Internal bleeding a major issue, can compress lungs or heart.

Anatomy and Physiology

• Ventilation vs. Oxygenation:
  • Ventilation: movement of air in and out of chest and lung tissue.
  • Oxygenation: delivering oxygen to blood via alveoli.
• Thoracic Cage: extends from neck to diaphragm.
• Intercostal Muscles: between ribs, expand rib cage during inhalation.
• Pleura:
  • Parietal pleura: inner chest wall lining.
  • Visceral pleura: lung covering.
  • Pleural fluid allows lung movement.
• Diaphragm: separates thoracic and abdominal cavity.

Mechanics of Ventilation

• Inhalation involves intercostal muscle contraction and diaphragm flattening.
• Exhalation is passive.
• Important to recognize increased work of breathing, indicating respiratory distress.

Injuries of the Chest

• Open vs. Closed Injuries:
  • Closed: caused by blunt trauma, may lead to cardiac or pulmonary contusion.
  • Open: caused by penetrating trauma, may result in pneumothorax or hemothorax.

Signs and Symptoms of Chest Injury

• Pain at injury site, bruising, crepitus, penetrating injuries, dyspnea.
• Hemoptysis, asymmetric chest expansion, rapid pulse, cyanosis.

Patient Assessment

Scene Size-Up

• Observe for hazards and ensure safety.
• Identify mechanism of injury and number of patients.

Primary Assessment

• Identify and treat life threats, determine transport priority.
• Check airway, breathing, circulation (ABCs).
• Look for paradoxical motion, asymmetrical chest rise.
• Use occlusive dressings for penetrating injuries.

Secondary Assessment

• Focus on isolated injury if mechanism is limited.
• Perform rapid full-body assessment in cases of significant trauma.

Reassessment

• Frequent reassessment critical to identify changes.
• Monitor vital signs, patient condition every 5 minutes.

Specific Injuries and Complications

Pneumothorax

• Simple Pneumothorax: air in pleural space, causes lung collapse.
• Tension Pneumothorax: life-threatening, causes mediastinum shift.

Cardiac Tamponade

• Fluid in pericardial sac compresses heart, reducing blood flow.
• Signs include jugular vein distension, narrowing pulse pressure.

Rib Fractures

• Common in older adults, significant mechanism of injury.
• Can lead to pneumothorax or other serious conditions.

Flail Chest

• Multiple rib fractures causing paradoxical chest motion.
• Requires respiratory support and careful monitoring.

Other Injuries

• Pulmonary Contusion: bruising of lung tissue causing hypoxia.
• Blunt Myocardial Injury: heart injury from blunt trauma, irregular pulse common.
• Commotio Cordis: sudden blow to chest causing cardiac arrest.
• Laceration of Great Vessels: massive hemorrhage potential, requires urgent care.

Emergency Management

• Ensure airway, breathing, circulation.
• Provide supplemental oxygen and ventilatory support as needed.
• Transport rapidly to appropriate facility.
• Communicate with hospital staff for preparedness.

Personal Protective Equipment

• Use PPE to avoid exposure to communicable diseases, especially in suspected respiratory viruses.
• Decontaminate units thoroughly after exposure to potential hazards.