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Chest Injuries

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Describe the emergency medical care of a patient with a sucking chest wound. ... Can occur from sealing all four sides of the dressing on a sucking chest wound. ... – PowerPoint PPT presentation

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Title: Chest Injuries


1
Chapter 22
  • Chest Injuries

2
Objectives
  • Differentiate between a pneumothorax, a
    hemothorax, a tension pneumothorax, and a sucking
    chest wound.
  • Describe the emergency medical care of a patient
    with a flail chest.
  • Describe the emergency medical care of a patient
    with a sucking chest wound.
  • Demonstrate the steps in the emergency medical
    care of a sucking chest wound.

3
The Chest
4
Organs of the Chest
5
Injuries to the Chest
  • Open chest injuries
  • Caused by penetrating trauma
  • Closed chest injuries
  • Caused by blunt trauma

6
Signs and Symptoms of Chest Injuries
  • Pain at the site of injury
  • Pain aggravated by increased breathing
  • Dyspnea
  • Hemoptysis
  • Failure of the chest to expand normally
  • Rapid, weak pulse and low blood pressure
  • Cyanosis around the lips or fingernails

7
Assessment of Chest Injuries
  • DCAP-BTLS
  • Chest wall movement
  • Paradoxical movement
  • Hemoptysis
  • Shock
  • Cyanosis

8
Complications of Chest Injuries
9
Pneumothorax
  • Air accumulates in the pleural space.
  • Air enters through a hole in the chest wall.
  • The lung may collapse in a few seconds or a few
    minutes.
  • An open or penetrating wound to the chest is
    called a sucking chest wound.

10
Caring for Open Pneumothorax
  • Clear and manage the airway.
  • Provide oxygen.
  • Seal an open wound with an occlusive dressing.
  • Depending on local protocol, tape down all four
    sides or create a flutter valve.

11
Spontaneous Pneumothorax
  • Some people are born with or develop weak areas
    on the surface of the lungs.
  • Occasionally, the area will rupture
    spontaneously, allowing air into the pleural
    space.
  • Patient experiences sudden chest pain and trouble
    breathing.
  • Consider a spontaneous pneumothorax in a patient
    with chest pain without cause.

12
Tension Pneumothorax
  • Can occur from sealing all four sides of the
    dressing on a sucking chest wound.
  • Can also occur from a fractured rib puncturing
    the lung or bronchus.
  • Can also result from a spontaneous pneumothorax.

13
Signs and Symptoms of Tension Pneumothorax
  • Respiratory distress
  • Distended neck veins
  • Tracheal deviation
  • Tachycardia
  • Low blood glucose level
  • Decreased lung sounds

14
Caring for Tension Pneumothorax
  • If a tension pneumothorax develops from sealing
    an open chest wound, partly remove the dressing
    to let the air escape.
  • If there is no open wound, follow local protocol.

15
Hemothorax
  • Collection of blood in the pleural space
  • Suspect if the following are seen
  • Signs and symptoms of shock
  • Decreased breath sounds on affected side
  • If both air and blood are present in the pleural
    space, it is a hemopneumothorax.

16
Rib Fractures
  • They are very common in the elderly.
  • A fractured rib may lacerate the surface of the
    lung.
  • Patients will avoid taking deep breaths and
    breathing will be rapid and shallow.
  • The patient often holds the affected side to
    minimize discomfort.
  • Administer oxygen.

17
Flail Chest (1 of 2)
  • Three or more ribs fractured in two or more
    places
  • Or when the sternum is fractured along with
    several ribs.
  • A segment of the chest wall may be detached from
    the rest of the thoracic cage.
  • Creates paradoxical movement.

18
Flail Chest (2 of 2)
  • Breathing is extremely painful and patient rarely
    receives adequate oxygenation.
  • Care includes
  • Maintaining the airway.
  • Providing respiratory support.
  • Performing ongoing assessment.
  • Immobilizing flail segment.

19
Pulmonary Contusion
  • Bruising of the lung
  • Develops over hours
  • Alveoli fill with blood, and edema accumulates in
    the lung, causing hypoxia.
  • Provide oxygen and ventilatory support.

20
Traumatic Asphyxia
  • Sudden, severe compression of chest
  • Produces rapid increase in pressure within chest
  • Results in neck vein distention, cyanosis, and
    bleeding into the eyes
  • Provide supplemental oxygen and monitor vital
    signs.
  • Arrange for immediate transport.

21
Blunt Myocardial Injury
  • Bruising of heart muscle
  • Pulse is often irregular.
  • There is no prehospital treatment for this
    condition.
  • Check patients pulse and note irregularities.
  • Provide supplemental oxygen and arrange for
    immediate transport.

22
Pericardial Tamponade
  • Blood or other fluids collect in the pericardium.
  • Signs and symptoms include
  • Very soft and faint heart tones
  • Weak pulse
  • Low blood pressure
  • Decrease in difference between systolic and
    diastolic blood pressure
  • Jugular vein distention (JVD)
  • Provide oxygen and arrange for prompt transport.

23
Laceration of the Great Vessels
  • The superior vena cava, inferior vena cava,
    pulmonary arteries and veins, and aorta are
    contained in the chest.
  • Injury to these vessels can cause fatal
    hemorrhaging.
  • Treatment includes
  • CPR
  • Ventilatory support
  • Supplemental oxygen
  • Arranging for immediate transport.
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