Chest Injuries

Key ventilation terms

  • tidal volume: the amount of air moved in and out of the lungs in a single breath

  • minute ventilation: tidal volume x breaths per minute

  • inhalation: diaphragm contracts and creates negative pressure

  • exhalation: intercostal and diaphragm muscles relax

Open Chest injuries

  • penetrating trauma

  • causes instant damage, but symptoms can develop over time

  • never remove in impaled object —> can increase massive hemorrhaging

Closed chest injuries

  • usually caused by blunt trauma

  • can cause pulmonary contusions, pneumothorax, hemothorax, cardiac tamponade, commotio cordis, rib fractures

Pneumothorax

  • simple

    • does not result in major changes in the patient’s hemodynamic status

    • can still cause hypoxia, monitor sp02 closely

    • can become tension later on, especially if PPV is administered

  • Open pneumothorax

    • hole in the chest wall allows for air to move freely between the outside the pleural space

    • treatment is an occlusive dressing

    • can become tension later on

  • tension pneumothorax

    • results from a build up of air in the pleural space that collapses lung and pushes mediastinum into opposite pleural cavity —> needle decompression is the only treatment which is done by ALS

    • absent lung sounds

    • JVD

    • hypotension

    • tracheal deviation —> can occur later

  • hemothorax

    • blood collects in the pleural space —> hemopnuemothorax is the combination of blood and air outside the lung walls

Cardiac Tamponade

  • the pericardium fills with blood of fluid and cannot pump effectively

  • becks triad: JVD, narrowing pulse pressures, muffled heart tones

  • pericardiocentesis

  • narrowing pulse pressures

Flail chest

  • 2 or more ribs fractured in 2 or more places

  • paradoxical motion of chest wall

  • continuously monitor —> can result in pneumothorax

  • positive pressure ventilations —> BVM

  • if breathing is normal, still do BVM because of internal splinting

Sternal and Clavicular Fractures

  • sternal: often the result of significant blunt trauma, may cause secondary injuries to lungs, great vessels, and heart

  • clavicular: may cause damage to neurovascular bundles, may cause secondary injuries, rib fractures

Commotio Cordis

  • caused by a direct blow to the chest during the relative refractory period of the heart rhythm

  • results in immediate cardiac arrest, often vfib

  • usually responds to immediate CPR and defibulation