CHEST TRAUMA

2
Introduction
External trauma to the chest
Potential to damage underlying organs
Consider the potential for problems such as spinal injury
and act accordingly.


3
Fractured Ribs
The most common chest injury.
Pain increases on movement, - impede the victim's ability to
breathe properly.
May cause damage to the underlying lung.
4
Fractured Ribs
Recognition
Pain at site which increases with movement or touch
Pain at site when breathing in
Difficulty breathing, Rapid shallow breathing
Rapid pulse
Bruising
Deformity
Bloody sputum
Guarding of the injury

5
Fractured Ribs
Management
Primary survey - act accordingly
Position of comfort
Stabilise the fracture site - Put the arm
on the injured side in a collar and cuff
or a sling.
Seek medical aid
Provide supplemental oxygen if able
Observe for respiratory compromise
6
Fractured Ribs: Creating a Sling
7
Pneumothorax (collapsed lung)
Air enters the between the lungs and the inside of the
chest wall (pleural space).
The air takes up space, causing a section of the lung to
collapse.
If air continues to enter - tension pneumothorax.
Causes: Spontaneous or trauma.
8
Pneumothorax
9
Pneumothorax (collapsed lung)
Recognition
Severe chest pain
Breathing distress (Rapid, shallow breathing)
Rapid pulse
Bluish skin colour (cyanosis)
Possible altered conscious state
Possible deviated windpipe (trachea)
Distended neck veins
10
Pneumothorax (collapsed lung)
First aid management:
Seek immediate medical aid,
Primary Survey,
Oxygen provision
Resuscitation if required
11
Flail Segment
When ribs and/or the breastbone are fractured in a number
of places and result in a free-floating section of bone.
12
Flail Segment
Recognition
As for fractured rib but more severe
Paradoxical breathing
13
Flail Segment
Management
Primary Survey
Urgent medical assistance
Position of comfort.
Stabilise the fracture site as for a
fractured rib
Provide supplemental oxygen
14
Sucking or Open Chest Wound
Penetrating chest injury.
Wound through the chest wall, through the pleura and into the
lung tissue.
This allow air to be sucked inwards on inspiration,
15
Sucking or Open Chest Wound
Recognition
Open wound to chest
Severe breathing difficulty
Rapid pulse
Sound of air being sucked in through wound

16
Sucking or Open Chest Wound
Management
Urgent medical assistance
Position the victim in a sitting position with
the injured side downwards
Cover the wound site with some air tight
material (e.g. polythene).
This dressing needs to be taped on three
sides with the bottom edge left free. This will
stop air being sucked in but will allow
trapped air to escape
Provide supplemental oxygen if able
Continuously monitor and reassure the
victim
If the victim becomes unconscious, conduct
a Primary Survey and take appropriate
action


Abdomen
Motor vehicle accidents
Pedestrian accidents
Penetrating trauma - knife wounds are more
common than gunshot wounds
External bleeding, protruding abdominal
contents
Signs of shock
Abdominal wound
First aid

Help injured person to lie down on a firm
surface
Loosen tight clothing, belts
Apply dressing over the wound
Transport to hospital
Abdominal wounds hospital
management

Diagnosis
Ultrasonography
CT

Treatment
Surgery - laparotomy
Spleen
Is the most commonly
injured intraabdominal
organ
Diagnosis is confirmed by
CT scan
Therapy -
splenectomy

Liver and Biliary Tree

The liver is the
most commonly
injured organ.
CT examination
Therapy - surgical
(suture, resection)
Stomach
Most gastric injuries are due to penetrating trauma
Blunt trauma is rare
If vomitus or gastric aspirate is bloody, an injury to the stomach
should be suspected.
Therapy: laparotomy
Other injuries of abdomen
Duodenum
Pancreas: pancreatic
trauma is
relatively uncommmen
Intestines
Colon and rectum
Major abdominal vessels
Urinary tract: blood in
urine