: A SEVERE CHEST INJURY. A, this patient has surgical emphysema—in spite of his alarming appearance, this part of his injury is benign. B, a brokenrib has punctured his lung, air has collected under pressure in his right pleuralcavity, compressed his right lung, and forced his mediastinum over to the left,impairing the ventilation of his left lung. Air has also escaped into his mediastinumand tracked up into his neck and face. Adapted from an original illustration byFrank H. Netter, M.D. from the CIBA collection of medical illustrations, copyright byCIBA Pharmaceutical Company, Division of CIBA–GEIGY Corporation.
THE RAPID ASSESSMENT OF A CHEST INJURY
If a patient’s airway is blocked, clear it as in Section 52.1.
If air is going in and out, but his breathing is distressed,
he may have multiple fracturedribs or severe abdominal pain.
If he is making great respiratory efforts, but is still hungry for air,
think of a flail chestor a pneumothorax.
If he is cyanosed in the presence of an adequate airway,
he may have a badly damagedlung, a flail chest, or a pneumothorax. Give him oxygen.Many patients with chest injuries breathe much more easily as soon as they are intubated.
THE HISTORY OF A CHEST INJURY
Assess the force of the patient’s injury carefully. The greater the force, the greater thechances that he has a severe injury.
THE EXAMINATION OF A CHEST INJURY
If a patient is conscious, and is now breathing easily, strip him to the waist, and ask him todescribe the pain and show you exactly where it is. if unconscious, remove his clothes andexamine his chest carefully.INSPECTION Assess the rate and depth of the patient’s breathing, while he is breathingnormally. Ask him to take a deep breath. If his ribs are broken, his attempts to do so willsoon be stopped by sharp pain.
Is his apex beat in its normal place? Feel in his suprasternal notch to find out if his tracheais displaced.Do both sides of his chest expand equally?2