Chapter 30: Chest Injuries

Introduction

• Focus on managing patients with chest trauma
• Recognize life-threatening injuries and provide immediate intervention
• Covers anatomy, physiology, pathophysiology, complications, assessment, and management
• Discusses age-related issues in pediatric and geriatric trauma
• Types of trauma: blunt vs. penetrating and open trauma

Statistics

• Chest trauma: over 1.2 million emergency visits annually
• Injuries can involve heart, lungs, and great vessels
• Blunt and penetrating traumas require immediate EMT response

Anatomy and Physiology

• Ventilation vs. Oxygenation:
  • Ventilation: air movement in/out of lungs
  • Oxygenation: oxygen delivery in blood
• Thoracic Cage: extends neck to diaphragm
  • Contains heart, lungs, great vessels
• Pleura: two layers allowing lung movement
• Intercostal Muscles: develop with age, assist in breathing
• Diaphragm: separates thoracic and abdominal cavities

Mechanics of Ventilation

• Inhalation: intercostal muscles and diaphragm contract
• Exhalation: relaxation of these muscles
• Tidal Volume: air moved per breath (~500ml)
• Minute Volume: tidal volume x breath rate

Types of Chest Injuries

• Closed Injuries: often from blunt trauma
  • Can cause cardiac and pulmonary contusions
• Open Injuries: involve penetrating objects
  • Immediate damage, symptoms develop over time

Signs and Symptoms

• Pain, bruising, crepitus, dyspnea
• Cyanosis, diminished breath sounds, low oxygen saturation

Patient Assessment

• Scene safety, mechanism of injury
• Primary Assessment: life-threatening issues first
• Airway and Breathing: ensure patency, monitor breathing efficacy
• Circulation: assess pulse and signs of shock

Transport Decision

• Priority for issues with airway, breathing, circulation
• Key signs: skin appearance, consciousness level

History and Secondary Assessment

• Focus on injury mechanisms and sample history
• Vital signs: pulse, respiration, blood pressure

Complications and Management

• Pneumothorax: air in pleural space, lung collapse
  • Tension pneumothorax: ongoing air accumulation
• Hemothorax: blood in pleural space
• Cardiac Tamponade: fluid in pericardial sac
  • Signs: distended jugular veins, narrow pulse pressure

Specific Injuries

• Rib Fractures: may cause lung complications
• Flail Chest: segment of chest wall detaches
• Pulmonary Contusion: blood in alveoli
• Sternal/Clavicle Fractures: risk of vascular damage

Special Cases

• Traumatic Asphyxia: severe chest compression
• Commotio Cordis: cardiac arrest from sudden impact
• Laceration of Great Vessels: potential fatal hemorrhage

Review Questions

• Aortic shearing is a leading cause of death in vehicle crashes
• Chest injury signs exclude hemoemesis
• Immediate action for open chest wound: occlusive dressing
• Main concern in pneumothorax: ventilatory inadequacy

Conclusion

• Effective management of chest injuries requires understanding anatomy, physiology, and quick assessment
• Early intervention can significantly affect outcomes in chest trauma cases
• Training and preparedness are key in emergency situations