Chapter 4 - Chest Trauma

MSTC, FT LEWIS WAMSTC, FT LEWIS WA

Chest TraumaChest Trauma

Lesson FourLesson Four

► Penetrating chest injuries may result from:Penetrating chest injuries may result from:

IEDsIEDs

Gunshot woundsGunshot wounds

Schrapnel injuriesSchrapnel injuries

Stab woundsStab wounds

StickStick

IntroductionIntroduction

Anatomy of the ThoraxAnatomy of the Thorax

►TracheaTrachea►LungsLungs►BronchiBronchi►MediastinuMediastinu

mm

►HeartHeart

Assess the casualtyAssess the casualty

► Identify signs and symptoms:Identify signs and symptoms:

AirwayAirway

BreathingBreathing

CirculationCirculation

Signs indicative of chest Signs indicative of chest injuryinjury

► ShockShock

► Cyanosis (bluish tint of lips, mouth, fingertips or nails)Cyanosis (bluish tint of lips, mouth, fingertips or nails)

► Dyspnea (shortness of breathing or difficulty breathing)Dyspnea (shortness of breathing or difficulty breathing)

► Hemoptysis (coughing up blood)Hemoptysis (coughing up blood)

► Open wounds (sucking or hissing sounds from the wound)Open wounds (sucking or hissing sounds from the wound)

► Frothy blood around the woundFrothy blood around the wound

► Chest not rising normally when casualty inhalesChest not rising normally when casualty inhales

► Pain in shoulder or chest that increases with breathPain in shoulder or chest that increases with breath

► Two or more adjacent ribs are fractured in at Two or more adjacent ribs are fractured in at least two places or separation of sternum least two places or separation of sternum from ribsfrom ribs

Flail ChestFlail Chest

CyanosisCyanosis

Assess RespirationsAssess Respirations

► Respiratory rate and effort:Respiratory rate and effort:

TachypneaTachypnea

BradypniaBradypnia

LaboredLabored

RetractionsRetractions

Locate and Expose Open Locate and Expose Open Chest WoundChest Wound

Cut, Remove, or tear clothing over woundCut, Remove, or tear clothing over wound

Do not remove stuck clothingDo not remove stuck clothing

Do not try to clean or remove objects fromDo not try to clean or remove objects from woundwound

Check for entry and exit wound (look and Check for entry and exit wound (look and feel)feel)

If entry and exit (same side), apply flutter-If entry and exit (same side), apply flutter-valve seal (three taped sides) to the wound on valve seal (three taped sides) to the wound on the front and a full seal (all four sides taped) the front and a full seal (all four sides taped) to the wound on the backto the wound on the back

Assessing The ChestAssessing The Chest

Compare Compare both sides of both sides of the chest at the chest at the same the same time when time when assessing for assessing for asymmetry.asymmetry.

Open Chest WoundOpen Chest Wound


Seal and Dress Open Chest Seal and Dress Open Chest WoundWound

Open field dressing wrapperOpen field dressing wrapper

Have casualty exhaleHave casualty exhale

Place wrapper over woundPlace wrapper over wound

Tape wrapper in placeTape wrapper in place

Apply field dressingApply field dressing

Secure dressing (tie directly Secure dressing (tie directly over the wound) over the wound)


Position casualty on side with injured Position casualty on side with injured side next side next to groundto ground

Allow casualty to sit up if it is easierAllow casualty to sit up if it is easier

Seek medical helpSeek medical help

Monitor breathingMonitor breathing

Treat for shockTreat for shock

EvacuateEvacuate

Impaled ObjectImpaled Object

Impaled ObjectImpaled Object

► If the casualty is unconscious or cannot If the casualty is unconscious or cannot hold his breath, place the airtight hold his breath, place the airtight material over the wound after the chest material over the wound after the chest falls but before it rises.falls but before it rises.

► If the casualty is conscious and wants If the casualty is conscious and wants to sit upright, allow him to sit with his to sit upright, allow him to sit with his back against a tree or other supporting back against a tree or other supporting object.object.

Open PneumothoraxOpen Pneumothorax



Petroleum Gauze can also be used to seal a sucking chest wound.

►Air enters thoracic space but Air enters thoracic space but cannot escape, pressure builds cannot escape, pressure builds and further collapses the lung and further collapses the lung and forces mediastinum and and forces mediastinum and heart away from effected lung. heart away from effected lung. May also compromise good lung May also compromise good lung and major vessels to the heart.and major vessels to the heart.

Tension PneumothoraxTension Pneumothorax

Tension PneumothoraxTension PneumothoraxTension PneumothoraxTension Pneumothorax

►Tension pneumothoraxTension pneumothorax is the is the second leading cause of preventable second leading cause of preventable death on the battlefield.death on the battlefield.

►Consider progressive, severe Consider progressive, severe respiratory distress resulting from respiratory distress resulting from unilateral chest trauma to represent unilateral chest trauma to represent a tension pneumothorax and a tension pneumothorax and decompress.decompress.


Air pushes over heart and collapses lung

Heart compressed not able to pump well

Air outside lung from wound

Tension PneumothoraxTension Pneumothorax Anxiety, agitation, apprehensionAnxiety, agitation, apprehension

Increasing dyspnea with cyanosisIncreasing dyspnea with cyanosis

TachypneaTachypnea

Tracheal shift (late sign)Tracheal shift (late sign)

Distended neck veinsDistended neck veins

Hypotension - loss of radial pulseHypotension - loss of radial pulse

Cool clammy skin, patient deteriorates rapidlyCool clammy skin, patient deteriorates rapidly

These signs are hard to detect in a combat environmentThese signs are hard to detect in a combat environment

Needle Chest Needle Chest DecompressionDecompression

► IndicationsIndications Penetrating chest wound with Penetrating chest wound with

progressive respiratory distressprogressive respiratory distress► Required MaterialsRequired Materials

10 to 14 gauge I.V. needle w/catheter 10 to 14 gauge I.V. needle w/catheter 2.5-3 in long2.5-3 in long

Betadine or Alcohol Prep PadsBetadine or Alcohol Prep Pads 1/2” Tape1/2” Tape


A needle chest decompression is A needle chest decompression is performed performed ONLYONLY if the casualty has if the casualty has a penetrating wound to the chest and a penetrating wound to the chest and increased difficulty breathing.increased difficulty breathing.

Performing a Needle Performing a Needle Chest DecompressionChest Decompression

Obtain a large bore (14 ga) needle Obtain a large bore (14 ga) needle and catheter unit and strip of tape and catheter unit and strip of tape from your aid bag.from your aid bag.


►Burp the wound:Burp the wound:

If no capability of NCD exists and the If no capability of NCD exists and the patient continues to have progressive patient continues to have progressive respiratory distress, remove the occlusive respiratory distress, remove the occlusive dressing and stick a gloved finger into the dressing and stick a gloved finger into the open wound and burp the wound.open wound and burp the wound.


► Review anatomy of the chest and Review anatomy of the chest and

identify the following anatomical identify the following anatomical

landmarks on the side of the open landmarks on the side of the open

wound & tension pneumothoraxwound & tension pneumothorax

Mid-clavicular lineMid-clavicular line

Second intercostal spaceSecond intercostal space

superior edge of the 3rd ribsuperior edge of the 3rd rib


► Steps for performing the procedure:Steps for performing the procedure: Casualty may be lying flat, sitting, etc. Casualty Casualty may be lying flat, sitting, etc. Casualty

positioning isn’t dependant on any specific position positioning isn’t dependant on any specific position for this procedurefor this procedure

Site preparation may be accomplished by using Site preparation may be accomplished by using either alcohol and/or betadine prep pads to either alcohol and/or betadine prep pads to disinfect the skindisinfect the skin

Using your index finger, trace the mid-clavicular Using your index finger, trace the mid-clavicular line, then identify the second intercostal space line, then identify the second intercostal space (between the second and third rib) on the side of (between the second and third rib) on the side of the tension pneumothoraxthe tension pneumothorax


►Steps for performing procedure:Steps for performing procedure: Insert the needle perpendicular to the Insert the needle perpendicular to the

chest wall, directly over the top of the chest wall, directly over the top of the third rib until a palpable pop is felt, third rib until a palpable pop is felt, followed immediately by a hissing or air followed immediately by a hissing or air escaping from the chest cavityescaping from the chest cavity

A rush of air confirms the diagnosis and A rush of air confirms the diagnosis and rapidly improves the patient’s conditionrapidly improves the patient’s condition

Performing a Needle Performing a Needle Chest DecompressionChest Decompression

Firmly insert the needle into the skin at a Firmly insert the needle into the skin at a 90 degree angle.90 degree angle.


ComplicationsComplications

Laceration of the intercostal Laceration of the intercostal vessels or nerve may cause vessels or nerve may cause hemorrhage or nerve damagehemorrhage or nerve damage

Questions????Questions????

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Chapter 4 - Chest Trauma