Chest Injuries

Skeletal Injury

Pulmonary injury
Chest injury

Heart and great vessels injury

Skeletal Injuries

clavicular fractures

rib fractures

flail chest

sternal fractures
Clavicular Fracture
 Clavicular Fracture
• The clavicle accounts for 5% of all fractures and is the most frequently
fractured bone in children.
• An isolated clavicular fracture is seldom a significant injury.
• It is common in children who fall on their shoulders or outstretched arms as
well as in athletes involved in contact sports.
• These injuries usually heal well within 4 to 6 weeks in children.
• In adults, healing can be somewhat prolonged, and surgery may be
recommended.
• Signs and symptoms include:
‾ Pain
‾ point tenderness
‾ Deformity

• Treatment usually involves applying a clavicle strap or a sling and swathe that
immobilizes the affected shoulder and arm for purposes of pain control
 rib fractures

The goals of treatment for rib fractures are to

relieve the pain and maintain pulmonary function
to prevent atelectasis. (The paramedic should
encourage the patient to cough and to breathe
deeply.)
 Flail chest
Prehospital management of patients with flail chest
includes assisting ventilation with high
concentration supplemental oxygen and providing
fluid replacement as needed.
Field stabilization of the flail segment is not
recommended.
As a rule, the most conservative methods for
obtaining adequate oxygenation and ventilation
should be used to manage patients with flail chest
 Pulmonary Contusion
Simple (Closed) Pneumothorax
Pulmonary Open Pneumothorax
injuries may
be classified as Tension Pneumothorax
Hemothorax
Traumatic Asphyxia
Simple (Closed) Pneumothorax

Caused by the presence of air in the pleural space, this air causes the lung to
partially or totally collapse
Can be caused by a fractured rib that penetrates the pleura and underlying
lung.
Pneumothorax may be caused by excessive pressure on the chest wall against
a closed glottis (paper bag effect) or by rupture or tearing of the lung tissue
and visceral pleura from no apparent cause (eg, spontaneous pneumothorax).

Treatment includes ventilatory support with high-concentration oxygen.

Patients should be carefully monitored for signs of a tension pneumothorax
because life-threatening consequences may develop if the pneumothorax is a
tension pneumothorax if it occupies more than 40% of the hemithorax
Patients are transported in the semi-Fowler position unless this position is
contraindicated by the mechanism of injury.
Open Pneumothorax
Prehospital treatment of an open pneumothorax

Close Provide Establish Transport

Close the chest Provide ventilatory Establish vascular Rapidly transport the
wound by first support as needed access en route to patient to an
applying direct with high- the hospital. appropriate medical
pressure with a concentration facility.
gloved hand. The oxygen, and monitor
chest wound can oxygen saturation.
then be sealed by
applying an occlusive
dressing or a dressing
of foil or plastic, and
securing it with tape
Prehospital treatment of an open pneumothorax

In theory, a three-sided dressing prevents the development

of a tension pneumothorax. However, it is now believed
to be more important to simply seal the hole in the chest
and expedite transport to a trauma center while
monitoring the patient for signs and symptoms consistent
with a tension pneumothorax. Specially manufactured
vented chest seals (as opposed to three-sided dressings
improvised in the field) do exist, and if one is available, it
is certainly acceptable and may confer a speed and safety
advantage relative to non vented occlusive dressings;
however, in the absence of a vented seal, a non vented
seal should be placed immediately
Tension Pneumothorax
Needle Decompression
 Needle Decompression
 The needle can be inserted anteriorly in the
second intercostal space in the
midclavicular line.
 It may also be placed in the fourth or fifth
intercostal space laterally on the involved
side
 The needle should be inserted just above
the rib. (This point is used to avoid the
nerve, artery, and vein that lie just beneath
each rib.)