deviation, unilateral absence of breath sounds, and neck vein distention because of increasedintrathoracic pressure. Rapid accumulation of even small amounts of blood in the pericardial sac(pericardial tamponade) which result in compression of the heart and inability of the heart to fillduring diastole. This results in decreased cardiac output. The patient may exhibit hypotension,tachycardia, muffled heart sounds, and neck vein distention.
Paraplegia associated with aortic injuries is related to ischemia or infarction of the spinal cord because of hematoma formation or occlusion of the blood flow from the aorta to the spinalarteries. Injuries in the neck region may also cause spinal cord or brachial plexus injuries,impairing motor or sensory function. Neck injuries may also produce cerebral ischemia or cerebral infarction resulting in motor or sensory impairment.
SELECTED THORACIC AND NECK INJURIES
Rib and Sternal Fractures
Rib fractures are the most common type of blunt chest injury
the injured area of lung underlyingthe fracture is usually of more clinical significance than the fracture. Fracture of the sternum,first, and/or second rib requires significant force and, therefore, may be associated with seriousinjuries of underlying structures. Left lower rib fractures may be associated with splenic injury,right lower rib fractures with hepatic injury, and stemal fractures with heart and/or great vesselin
' Stemal fracture is associated with a blunt injury (e.g., the chest impacting with thesteering wheel). The most common fracture site is the junction of the manubrium and the body of the sternum (angle of Louis) which is adjacent to the 2
intercostal space.SIGNS AND SYMPTOMS
Dyspnea• Localized pain on movement, palpation, or inspiration• Patient assumes a position intended to splint the chest wall to reduce pain• Chest wall ecchymosis or sternal contusion
• Bony crepitus or deformity
Flail chest is defined as a fracture of two or more sites on two or more adjacent ribs or when ribfractures produce a free-floating sternum. The unsupported chest wall or flail segment moves paradoxically or opposite from the rest of the chest wall during inspiration and expiration. Flailsegments may not be clinically evident in the first several hours after injury' because of musclespasms that splint the flail
segment. Once positive pressure is initiated, paradoxical chestwall movement ceases. A flail chest may
be associated with the following:
• Ineffective ventilation• Pulmonary' contusion• Lacerated lung
SIGNS AND SYMPTOMS
• Chest wall pain• Paradoxical chest wall movement—the flail segment moves in during inspiration and outduring expiration