Chapter 27

flail chest

fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment

paradoxal motion

movement of ribs in a flail segment that is opposite to the direction movement of the rest of the chest cavity

compression injuries develop from severe blunt trauma in which the chest is rapidly compressed, such as when

a driver strikes his chest on the steering column or when a person is trapped in a trench-wall collapse

flail chest occurs when blunt trauma creates a fracture of

two or more ribs in two or more places

sucking chest wound

an open chest wound in which is “sucked” into the chest cavity

watch the pt’s respiratory rate and depth. if respirations become too shallow,

assist ventilations

seal the open chest wound as quickly as possible. if need be, use your

gloved hand. do not delay sealing the wound to find an occlusive dressing

the danger of a pneumothorax and tension pneumothorax is the reason medical authorities

recommend the flutter valve (three sided) occlusive dressing instead of an occlusive dressing sealed on all four sides

you may have to maintain hand pressure over the occlusive dressing en route to the hospital. the tape also may not stick well to

bloody skin or to skin that is sweaty from shock

foil edges may lacerate the pt’s skin and may

tear when lifted to release pressure

the chest can hold more than

3L of blood

pneumothorax

air in the chest cavity

tension pneumothorax

type of pneumothorax in which air that enters the chest cavity is prevented from escaping

what can shift to the opposite side and is a very late sign and difficult to detect

the trachea

traumatic asphyxia

associated with sudden compressions of the chest. when this occurs the sternum and the ribs exert severe pressure on the heart ad lungs, forcing blood out of the right atrium and up into the jugular veins in the neck

cardiac tamponade

when an injury to the heart causes blood to flow into the surrounding pericardial sac

the aorta can be damaged without

trauma

degeneration of the aorta, often worsened by high blood pressure or other diseases, causing

weakening of this large vessel

aortic dissection Is a condition where the inner layer of the wall of the aorta

begins to tear

blood from the interior of the vessel leaks into the outer layers and eventually causes

a balloon-like profusion, called an aneurysm

the pt may have differences in pulse or blood pressure between the right and left arms or differences in pulses between the

arms and the legs or the legs themselves (in abdominal aortic injury)

commotion cordis uncommon condition that is easy to recognize and treat. when somebody gets hit in the center of the chest, the result is

usually a bruise or even perhaps a fracture.

in commotion cordis , how ever, the impact occurs just when the heart is

vulnerable

there are several hundredths of a second during each heart beat when the heart, if sufficiently stimulated, will go

inro ventricular fibrillation (VFIB)

an examine of this is a young athlete who tries to catch a baseball but misses. the ball strikes him

in the center of the chest and the pt collapses in cardiac arrest

evisceration

an intestine or other internal organ protruding through a wound in the abdomen

the liver is very vascular; therefore, when it is injured, it can bleed

profusely, often to the point of life-threatening blood loss

hollow organs in the abdomen include

stomach, small and large bowels, gallbladder, and urinary bladder

if these organs are injured, they often spill their contents into the

abdominal cavity, leading to severe irritation and often peritonitis

for abdominal injuries

control external bleeding and stress all open wounds, do not touch or try to replace any eviscerated, or exposed, organs apply a sterile dressing moistened with sterile saline over the wound site