Chapter 4 - Chest Trauma

Chest Trauma Lesson Four MSTC, FT LEWIS WA

Introduction ►

Penetrating chest injuries may result from:  IEDs  Gunshot wounds  Schrapnel injuries  Stab wounds  Stick

Anatomy of the Thorax ►Trachea ►Lungs ►Bronchi ►Mediastinu

m

►Heart

Assess the casualty ► Identify

signs and symptoms:

 Airway  Breathing  Circulation

Signs indicative of chest injury

►

Shock

►

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

►

Dyspnea (shortness of breathing or difficulty breathing)

►

Hemoptysis (coughing up blood)

►

Open wounds (sucking or hissing sounds from the wound)

►

Frothy blood around the wound

►

Chest not rising normally when casualty inhales

►

Pain in shoulder or chest that increases with breath

Flail Chest ► Two

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

Cyanosis

Assess Respirations ► Respiratory

rate and effort:

 Tachypnea  Bradypnia  Labored  Retractions

Locate and Expose Open Chest Wound  Cut, Remove, or tear clothing over wound  Do not remove stuck clothing  Do not try to clean or remove objects from wound  Check for entry and exit wound (look and feel)  If entry and exit (same side), apply fluttervalve seal (three taped sides) to the wound on

Assessing The Chest 

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

Open Chest Wound

Open Chest Wound

Seal and Dress Open Chest Wound  Open field dressing wrapper

 Have casualty exhale  Place wrapper over wound  Tape wrapper in place  Apply field dressing  Secure dressing (tie directly over the wound)

Open Chest Wound  Position casualty on side with injured side next to ground  Allow casualty to sit up if it is easier  Seek medical help  Monitor breathing  Treat for shock  Evacuate

Impaled Object

Impaled Object ► If

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

► If

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

Open Pneumothorax

Open Pneumothorax

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

Tension Pneumothorax ►Air

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

Tension Tension Pneumothorax Pneumothorax ►Tension

pneumothorax is the

second leading cause of preventable death on the battlefield.

► Consider

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

Tension Pneumothorax

Air pushes over heart and collapses lung Air outside lung from wound

Heart compressed not able to pump well

Tension Pneumothorax 

Anxiety, agitation, apprehension



Increasing dyspnea with cyanosis



Tachypnea



Tracheal shift (late sign)



Distended neck veins



Hypotension - loss of radial pulse



Cool clammy skin, patient deteriorates rapidly



These signs are hard to detect in a combat environment

Needle Chest Decompression ► Indications

 Penetrating chest wound with progressive respiratory distress ► Required

Materials  10 to 14 gauge I.V. needle w/catheter 2.5-3 in long  Betadine or Alcohol Prep Pads  1/2” Tape

Needle Chest Decompression A needle chest decompression is performed ONLY if the casualty has a penetrating wound to the chest and increased difficulty breathing.

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

Tension Pneumothorax ► Burp

the wound:

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

Needle Chest Decompression ►

Review anatomy of the chest and identify the following anatomical landmarks on the side of the open wound & tension pneumothorax 

Mid-clavicular line



Second intercostal space



superior edge of the 3rd rib

Needle Chest Decompression ► Steps

for performing the procedure:

 Casualty may be lying flat, sitting, etc. Casualty positioning isn’t dependant on any specific position for this procedure  Site preparation may be accomplished by using either alcohol and/or betadine prep pads to disinfect the skin  Using your index finger, trace the mid-clavicular line, then identify the second intercostal space (between the second and third rib) on the side of the tension pneumothorax

Needle Chest Decompression ► Steps

for performing procedure:

 Insert the needle perpendicular to the chest wall, directly over the top of the third rib until a palpable pop is felt, followed immediately by a hissing or air escaping from the chest cavity  A rush of air confirms the diagnosis and rapidly improves the patient’s condition

Performing a Needle Chest Decompression Firmly insert the needle into the skin at a 90 degree angle.

Needle Chest Decompression

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

Questions????