EMT - Chest Injuries

Neurovascular Bundle

lies closely along the lowest margin of each rib, sensitive

Spinal Injuries

• spinal injuries below C5 can still breathe from the diaphragm

• spinal injury above C3 may lose ability to breathe

Tidal Volume

amount of air moved into or out of lungs in one breath (about 500mL)

• minute ventilation = tidal volume x breaths/min

Closed Chest Injury

can cause significant cardiac pulmonary contusion → may cause dysrhythmia

Signs/Symptoms

obtain in secondary assessment

• pain at site of injury

• localized pain increased with breathing

• crepitus with palpation of the chest

• diminished breath sounds, unilateral chest rise

• rapid, weak pulse

• low BP

Treatment

• auscultate multiple locations to assess breath sounds

• c-spine for any big MOI (head trauma, LOC, etc)

• occlusive dressings to all penetrating injuries (back/chest/neck/abd-upper)

• JVD, absent lung sounds, O2 stats dropping → remove and replace dressing/valve

• support ventilations

Hemothorax

blood in the lungs

• muffled lung sounds

• dull on palpation

• late stage tracheal deviation, no JVD

• hemopneumothorax → flat neck veins

Traumatic Asphyxia

sudden/severe compression of the chest

• backflow of the blood to the head

• increased intrathoracic & intracranial pressure

• bruising above trauma site

Cardiac Tamponade

accumulation of fluid in the pericardial sac

• heart is compressed and cannot fill up properly

• Beck’s triad → JVD, muffled/distant heart sounds, low BP (narrow pulse pressure)

Myocardial Contusion

• presents as a heart attack → look at MOI

• chest bruising, irregular pulse

Commotio Cordis

• impact at critical portion of QRS complex

• causes irregular heartbeat → V-fib

• needs AED asap