L19 - Injuries to the Chest and Abdomen

Explain why injuries to the chest and abdomen can be life-threatening.

• They can damage soft tissues, bones, and internal organs

  • The ribs protect the lungs 

  • The sternum protects the heart

Open chest vs Closed chest

• Open chest wounds occur when an object, such as a stick, knife, or bullet, penetrates the chest wall

  • Fractured ribs may break through the skin to cause an open chest injury

• Closed chest wound does not break the skin

  • Closed chest wounds are generally caused by blunt objects, such as steering wheels, or falling onto an object

List signs and symptoms of a chest injury.

1. Trouble breathing or no breathing.

2. Severe pain at the site of injury.

3. Flushed, pale, ashen, or bluish skin.

4. Obvious deformity, such as that caused by a fracture.

5. Coughing up blood may be bright red or dark like coffee grounds.

6. Bruising at the site of a blunt injury, such as that caused by a seatbelt.

7. A "sucking" noise or distinct sound when the person breathes

Describe how to care for rib fractures.

1. Have the person rest in a position that will make breathing easier.

2. Encourage the person to breathe normally if tolerated.

3. Do not move the person if you suspect a head, neck, or spinal injury.

4. If needed, call 9-1-1.

5. If transporting the person to the hospital will not make the injury worse, stabilize the injury and transport.

6. Give the person a blanket or pillow to hold against the fractured ribs to support and immobilize the area.

7. Use a sling and binder to hold the persons arm and/or blanket against the injured side of the chest.

8. Monitor breathing.

9. Take steps to minimize shock.

Describe how to care for an open chest wound.

1. Call 9-1-1.

2. If the open chest wound is bleeding severely, apply firm, direct pressure with your gloved hand and a dry, sterile gauze dressing or item of clothing to the wound edges.

3. If bleeding stops or is minimal, leave the wound uncovered while waiting for EMS personnel to arrive.

4. If the bleeding is significant and continues, periodically remove your hand and check to see if the dressing has become soaked with blood or a clot, thus inadvertently creating an occlusive dressing.

   • The use of an occlusive dressing or a dressing that becomes saturated with blood can cause an immediate life-threatening condition known as a tension pneumothorax.

   • Because it can be difficult to recognize a tension pneumothorax, and because most chest wounds do not typically bleed severely from the external surface, it is recommended to not cover an open chest wound. This is an exception to the rule of never removing the original dressing on a bleeding wound. 

5. Monitor the person's breathing.

6. Take steps to minimize shock by having the person lay down on their back.

Describe how to care for an impaled object in the chest

1. Call 9-1-1.

2. Do not remove the object, unless it interferes with chest compressions.

3. Stabilize the object to prevent further damage.

4. Remove clothing to expose the wound.

5. Control bleeding by applying direct pressure to the edges of the wound (but avoid placing direct pressure on the object).

6. Use a sterile bulky dressing or gauze around the object to hold it in place.

7. Carefully packed the dressing around the object.

8. Secure the sterile bulky dressing in place with gauze, a triangular bandage, or tape.

List the signs and symptoms of abdominal injuries

1. Severe abdominal pain.

2. Bruising.

3. External bleeding.

4. Nausea and vomiting (sometimes vomit containing blood).

5. Pail, ashen, cool, moist skin.

6. Weakness.

7. Thirst.

8. Pain, tenderness or tight feeling in the abdomen.

9. Organs protruding from the abdomen.

10. Rigid abdominal muscles.

11. Other signs and symptoms of shock.

Describe how to care for abdominal injuries. (OPEN WOUND)

1. Put on disposable gloves.

2. Do not apply direct pressure.

3. Do not push any protruding organs back into the open wound. 

4. Remove clothing from around the wound. Apply a moist clean sterile dressing loosely over the wound.

5. Cover the dressing loosely with plastic wrap if available, making an occlusive dressing.

6. Cover the dressing lightly with a folded towel to maintain warmth.

7. Keep the person from getting chilled or overheated

Describe how to care for abdominal injuries. (CLOSED WOUND)

1. Carefully position the person on their back with the knees bent, if that position does not cause pain.

2. Bending the knees allows the muscles of the abdomen to relax. Avoid putting direct pressure on the area.

3. Place rolled up blankets or pillows under the persons knees if available.

4. Shock is likely to occur with any serious abdominal injury.

   • Take steps to minimize shock by having the person lie on their back.

   • Keep the person from becoming chilled or overheated, and monitor breathing and how the skin looks and feels until EMS personnel arrive.

Describe how to care for abdominal injuries. (IMPALED OBJECT)

1. Do not remove the object.

2. Dress the wound around the object to control bleeding.

3. Stabilize the object with bulky dressings to prevent movement.