Chest InjuriesBy Briony OsborneMr. Zakris

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Chest Injuries

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Introduction to Chest Injuries

Chest injuries are serious injuries that may result

from either a blunt or penetrating force to the chest

region. Injuries to the chest region are particularly

taken seriously as they can cause damage to such

underlying organs as the lungs and heart. Pressure

may be applied to these organs even without external

injury, causing trauma and resulting in cases such as

pulmonary barotrauma. Chest injuries may also result

in spinal injuries, which is another reason why chest

injuries should be handled with absolute seriousness.

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Fractured RibsOne of the most common injuries to the chest is fractured ribs. Fractured ribs are caused by trauma to the chest cage and may result in one or multiple ribs being fractured. Rib fractures are very painful, especially during movement which is why breathing can often become an added problem to the casualty with the fractured rib. The pain of the fracture impairs the casualty’s ability to breathe. There is also a chance that an underlying lung could be hurt as a result of a fractured rib.

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Recognition of a Fractured Rib

• Pain at site which increases with movement or touch.

• Bruising• Deformity• Sometimes bloody sputum• Difficulty breathing

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Bruising: Bruising to the chest may be an indication of a fractured rib.

Management of a Fractured Rib1. Conduct a primary survey2. Help the casualty to a comfortable position,

this is often a still position with the injured side facing downwards.

3. Stabilise the fracture site. This may be done with a pad or pillow or even by a hand being placed over the affected area. The site can be further stabilised by securing the upper arm on the injured side tying a broad bandage off on the injured side of the body. Then an elevation sling can then be used to support the arm on the injured side.

4. Provide supplemental oxygen if able.

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Flail SegmentA flail segment is when the ribs or the sternum have a fracture in multiple places resulting in a free-floating section of bone in the chest region.

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Recognition of a Flail Segment

• Pain at site which increases with movement or touch.

• Bruising• Deformity• Sometimes bloody sputum• Difficulty breathing• Paradoxal breathing (meaning that the flail section moves in the opposite direction to the rest of the rib cage when the victim is breathing).

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Bloody Sputum: Bloody sputum may be an indication of a flail segment.

Management of a Flail Segment1. Conduct a primary survey2. Call an ambulance urgently3. Help the casualty into a position

where it is easiest for them to breathe.

4. Stabilise the affected site as for a fractured rib

5. Provide supplemental oxygen if able.

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Collapsed LungA collapsed lung can happen spontaneously or as result of over pressurisation of the lung and occurs when air enters the area outside the lungs, which raises the pressure above that inside the lungs. This causes a section of the lung to collapse. Tension pneumothorax will occur if air continues to enter this space and cannot escape.

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Recognition of Collapsed Lung

• Severe chest pain• Severe breathing difficulty

• Bluish skin colour (cyanosis)

• Reduced level of consciousness

• Deviated windpipe (trachea)

• Enlarged neck veins• Reduced chest movement on injured side

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Chest Pains: Chest pains may be an indication of a collapsed lung.

Management of a Collapsed Lung1. Seek immediate medical aid2. Conduct a primary survey3. Provision of oxygen

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Sucking or Open Chest WoundA chest injury where a wound to the chest penetrates through the chest wall, through the pleural space and into the lung itself can cause a sucking chest wound. This severe open wound allows air to be sucked into the chest cage, this occurs during inspiration and can possible cause a tension pneumothorax.

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Recognition of a Sucking or Open Chest Wound

• Open wound to chest• Severe breathing difficulty

• Sound of air being sucked in through wound.

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Open wound to the chest: An open chest wound is an indication of a sucking or open chest wound.

Management of a Sucking or Open Chest Wound

1. Call an ambulance urgently2. Conduct a primary survey.3. Help the victim into a semi-recumbent

position with the injured side downwards.4. Cover the wound site with air tight

material, if possible the dressing should be taped down on three sides, with the bottom edge left free.

5. Provide supplemental oxygen if able.6. Continuously monitor and reassure the

casualty.7. If the casualty becomes unconscious,

conduct a primary survey.

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Bibliography Websites:

- Unknown (2006) “parasol EMT”. (online) http://images.google.com.au/imgres?imgurl=http://www.parasolemt.com.au/Images/first_aid_online/fractured.jpg&imgrefurl=http://. Retrieved 8.8.08 – 25.8.08

- Unknown. (no date). “Flail Chest”. (online) http://images.google.com.au/imgres?imgurl=http://www.911emg.com/images/aid_Page_61Retrieved 8.8.08 – 25.8.08

- Unknown. (no date). “Cystic Fibrosis” (collapsed lung). (online). http://images.google.com.au/imgres?imgurl=http://www.moondragon.org/images/collapsedlung.jpg. Retrieved 8.8.08 - 25.8.08

- Unknown. (no date). “Wounds of the Extremities” (sucking or open chest wound). (online). http://images.google.com.au/imgres?imgurl=http://history.amedd.army.mil/booksdocs/wwii/woundblstcs. Retrieved 8.8.08 - 25.8.08

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Bibliography Continued.Books:

- Lippmann, J. and Natoli, D. (2006) Royal Life Saving: First Aid. L.J. Publications: Ashburn, Victoria, Australia.

- Balint, D. (2007). First Aid. Able Publishing:Melbourne

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