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Overview of Chest

Can be life-threatening
May result in damage to either the heart or the lung and
cause severe internal bleeding
Rib cage fractures may result in serious injury to vital
Deep, open wounds allow air to enter the chest cavity
Closed wounds usually involve injury to the ribs and
possibly underlying structures

Signs of Chest Injuries

An obvious chest wound
Impaired breathing
Irregular or lack of chest expansion
Coughing-up of blood
Subcutaneous emphysema: crackling sensation

Closed Chest Injuries

Rib fracture
Flail chest

Rib Fracture
Rib fractures are almost always the result of
trauma (a blow) to the rib cage
Signs and Symptoms

leaning toward the injured side

if the rib has punctured a lung, air can escape into the
tissues of the chest wall creating a crackling
sensation (- Subcutaneous Emphysema)
unwillingness to take a deep breath
complaining of local pain and tenderness
pain when moving the rib cage when breathing or

Rib Fracture

Give oxygen
Make the patient as comfortable as possible
Activate EMS and treat as Load and Go

Transport patient
in the position of maximum comfort on the injured

Flail Chest
Several adjacent ribs fractured in more than one
place can produce a loose section of the chest
The flail section moves inward when the patient
breathes in, and outward when the patient
breathes out
This phenomenon is known as paradoxical

Flail Chest

Signs and symptoms

shortness of breath
swelling over the injury site
muscle splinting of the injury site
severe pain on inhalation/exhalation
possible paradoxical movement

Flail Chest

Give oxygen as soon as possible
Be prepared to give AR
Help the patient get in a comfortable position and
transport to medical aid.
Activate EMS and treat as Load and Go
Continue to monitor vital signs
Unless there is substantial bleeding, do not apply
bulky padding or dressings


Use of Dressings on a
Flail Chest

Only consider taped-on pad as a treatment in the

following cases:
if there is likely to be a prolonged time before evacuation and
access to medical care
if the patient has fatigued their chest muscles

To apply dressings
Press the segment inward with your gloved hand to stabilize it
Splint in the inward position with a pillow, large bulky dressing, or
folded blanket or parka
Secure this thoroughly in place with tape
Be prepared to help breathing with AR
Do not hold in place with bandages encircling the chest. This
would further impair the patients breathing effort


Is a condition that results from air entering the

interpleural space. The air in the interpleural
space compresses the lung and prevents normal

There are two types of pneumothorax:

Tension pneumothorax
Spontaneous pneumothorax



Signs and symptoms

reduction of normal respiratory movements on the
affected side
a fall in blood pressure
weak and rapid pulse
a sudden sharp chest pain



Treatment for Tension Pneumothorax

Give oxygen
Activate EMS and treat as Load and Go
Continue to monitor vital signs

Treatment for Spontaneous Pneumothorax

Give oxygen
Transport to medical aid
The patient may prefer to be transported sitting up.


Open Chest Injuries

In penetration injuries of the chest wall, air can

enter the interpleural space from the outside,
causing the lung to collapse

Air moving back and forth through the chest wall

results in what is often called a sucking chest
wound, because of the sucking sound during


Open Chest Injuries

Signs and symptoms

increasing difficulty in breathing
frothy blood at the mouth/site of wound
rapid, weak pulse
falling blood pressure
localized chest pain


Open Chest Injuries

Seal the wound with any airtight material
Tape the material in place on three sides. Leave the bottom
(based on patient position) side unsealed to release
accumulated air
Continually monitor the dressing to ensure that the seal is
effective on inspiration only

Transport the patient

in a position of comfort
in a position which will not impair breathing
give oxygen
monitor vital signs
activate EMS and treat as Load and Go

Impaled Objects
Impaled objects are things such as broken glass
or large splinters that are both embedded into
and protruding from the body
Signs and Symptoms

Impaled objects are easily identified by sight


Impaled Objects

do not move or remove the object
build up a dressing around the object to hold it in place during
tape the dressing in place

Transport the patient

in the most comfortable position possible

monitor respiration transport to medical aid immediately.
activate EMS and treat as Load and Go
continue to monitor vital signs

If the object is obviously dangling from the skin or will

cause extreme further damage, it should be removed