Chest Injuries

Overview and Statistics

Chest trauma accounts directly for 25% off all trauma deaths

Contributing factor to approx another 50%

Majority can be managed in hospital with drainage and resus only 10-15% require surgery

Major causes are RTC, Industrial accidents & sporting injuries

Most common problem associated with chest injuries is HYPOXIA caused by impaired ventilation or secondary to hypovolemia

Spleen holds 150ml blood

Solid organs bleed

Hollow organs burst

What can get injured?

Heart

Blood Vessels

Lungs

Airways

Soft Tissue

Bones

Spinal Cord

Nerves

If rib injuries think:

Liver

Kidney

Spleen

Stomach, Pancreas, Gall Bladder

MOI

Blunt force - RTC, Fall, Sports injuries - scene time <20 mins

Penetrating - On scene time of minutes

Force and energy delivered

Duration and direction

Chest Injury S&S

Hypoxia, Dyspnoea, Tachypnoea, Bradypnoea

Shallow resps and use of accessory muscles

Abnormal chest wall movement

Deformity, bruising, swelling, wounds

Pain, tenderness

Obvious blood loss and signs of clinical shock

Reduced LoC

Anxiety

Fractured Rib

Be suspicious for other injuries

Most common chest injury

Can cause patient to breathe shallowly leading to inadequate ventilation

100-125ml blood loss

Can cause damage to soft tissue including lung causing more serious injuries

Fractured Sternum

1 in 20 PT with blunt force thoracic trauma

The # itself is not serous nut indicated SIGNIFICANT probability of other injuries

Such a strong bone force required to fracture it will have caused other injuries

More than ¼ of PT with # sternum will die

Flail Chest

Two or more rib and sternum # in two or more places

Usually from blunt trauma

Chest loses rigid support segment

The fail segment moved in and out on inspiration and outwards on expiration because of this movement the lung might not be adequately ventilated

Think with each rib approx 100ml of blood loss so this is more ad many #

Pneumothorax

Lungs surrounded by plural membrane that has two layers

Outer - Parietal Pleura - lines chest wall

Inner - Visceral Pleura - Covers the lings

Between them is pleural space

Pneumothorax is air in the pleural space

Can be spontaneous with no obvious cause

Can be caused by trauma

Symptoms depend on size and amount of air collecting and can be time critical and life threatening

Can out pressure on lung causing it to collapse

Can cause other structures to shift (eg trachea)

Can put pressure on blood vessels returning to the heart causing obstructive shock

Open Pneumothorax

Occurs from penetrating trauma hole in chest wall allows air to enter pleural space

If wound is large enough may be free movement of air in and out of affected lung during respitation

Can be referred to as sucking chest wound

Tension Pneumothorax

When air enters thoracic cavity but can’t escape

As it expands it occupies space in the cavity , the lung collapses and structures shift away impeding blood flow

PT may become:

Dyspnoeic, tachycardic, hypotensive

Reduced chest wall movement, reduced or absent breath sounds, distended neck veins, tracheal deviation

Haemothorax

Blood on thoracic pleural cavity

Usually from penetrating trauma injuring major blood vessels but could be shearing injury

As blood fills takes up space normally occupied by lungs and they collapse

PT has a dual problem Hypoxia and Hypovolemia

Cardiac Tamponade

Excessive fluid in pericardial sac compresses heart limiting it’s ability to pump

More common in penetrating injury

Only requires 20-30ml of blood to cause a tamponade

Subcutaneous Emphysema

Air or gas trapped in tissues beneath the skin

Associated with severe thoracic injury

Extra-pleural

Intra-pleural

Entonox in Chest Injuries

JRCALC contraindication and caution as risk of enlarging pneumothorax

Wound Dressings

Russell chest seal

Corius chest seal

Fox chest seal

Myocardial Contusion

Bruise on heart can cause rhythm disturbance