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    EMT Basic - Chest Trauma

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    Paulhotvw67
    Chest trauma can involve injuries to the thoracic cavity organs and vessels like the lungs, heart, and great vessels. Key considerations include pneumothorax, hemothorax, flail chest, and tension pneumothorax which can all cause respiratory distress and require rapid transport. Assessment looks for respiratory distress, decreased breath sounds, tracheal deviation, and other signs of injury like rib fractures, penetrating wounds, or swelling. Management prioritizes oxygen, dressing wounds, treating injuries like tension pneumothorax, and rapid transport given the risk of declining respiratory function or cardiovascular collapse.

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    EMT Basic - Chest Trauma

    Uploaded by

    Paulhotvw67
    2K views56 pages
    Chest trauma can involve injuries to the thoracic cavity organs and vessels like the lungs, heart, and great vessels. Key considerations include pneumothorax, hemothorax, flail chest, and tension pneumothorax which can all cause respiratory distress and require rapid transport. Assessment looks for respiratory distress, decreased breath sounds, tracheal deviation, and other signs of injury like rib fractures, penetrating wounds, or swelling. Management prioritizes oxygen, dressing wounds, treating injuries like tension pneumothorax, and rapid transport given the risk of declining respiratory function or cardiovascular collapse.

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    EMT Basic Chest Trauma Lecture

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    Chest trauma can involve injuries to the thoracic cavity organs and vessels like the lungs, heart, and great vessels. Key considerations include pneumothorax, hemothorax, flail chest, and tension pneumothorax which can all cause respiratory distress and require rapid transport. Assessment looks for respiratory distress, decreased breath sounds, tracheal deviation, and other signs of injury like rib fractures, penetrating wounds, or swelling. Management prioritizes oxygen, dressing wounds, treating injuries like tension pneumothorax, and rapid transport given the risk of declining respiratory function or cardiovascular collapse.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX or read online from Scribd
    Download as pptx
    2K views56 pages

    EMT Basic - Chest Trauma

    Uploaded by

    Paulhotvw67
    Chest trauma can involve injuries to the thoracic cavity organs and vessels like the lungs, heart, and great vessels. Key considerations include pneumothorax, hemothorax, flail chest, and tension pneumothorax which can all cause respiratory distress and require rapid transport. Assessment looks for respiratory distress, decreased breath sounds, tracheal deviation, and other signs of injury like rib fractures, penetrating wounds, or swelling. Management prioritizes oxygen, dressing wounds, treating injuries like tension pneumothorax, and rapid transport given the risk of declining respiratory function or cardiovascular collapse.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX or read online from Scribd
    Download as pptx
    of 56
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    The document discusses different types of chest injuries including pneumothorax, hemothorax, flail chest, and cardiac tamponade. It also covers assessment techniques and treatments.

    The document discusses closed and open chest injuries including pneumothorax, hemothorax, flail chest, sucking chest wounds, and cardiac tamponade.

    Signs and symptoms of a tension pneumothorax include shortness of breath, increased respiratory rate and effort, distended neck veins, decreased breath sounds on the affected side, and hypotension.

    Chest Trauma

    Organs/Vessels
    n Thoracic cavity
    u Ribs

    u Diaphragm

    u Mediastinum (trachea, vena cava, aorta,

    esophagus, heart)
    u Lungs
    Chest Anatomy
    Pleura
    n 2 Layers
    u Keep lungs expanded

    u Visceral layer

    u Parietal layer

    n Pleural space
    u Small amount of fluid
    Pericardial Cavity
    n Fibrous pericardium
    n Epicardium
    n Potential space - < 50 ml of fluid
    Other Considerations

    Liver and spleen located under lower ribs


    Trauma Below nipples – Assume abdominal injuries
    Trauma Above nipples – Assume cervical spine injury
    Always consider spinal column trauma
    GSW can damage both cavities
    Chest and abdominal trauma victims get high flow oxygen
    Other Considerations
    n Major chest and abdominal trauma
    regularly occur together
    n When you see one, look for the other
    n I bet you will find it
    Hypoxia Consideration
    (End Point)
    n Airway obstruction inadequate oxygendelivery
    n Hypovolemia from blood loss
    n Ventilation/perfusion mismatch from lung
     injury
    n Changes in pleural pressures
    n Pump failure  Manage hypoxia!!
     Airway control

     Rapid Transport


    Trauma Injury Effects
    n
    n
    n
    n
    n
    Deadly Dozen
    n Airway obstruction Traumatic aortic rupture

    n Open pneumothorax Tracheal/bronchial tree

    n Tension pneumothorax injury


    n Massive hemothorax Myocardial contusion

    n Flail chest Diaphragmatic tears

    n Cardiac tamponade Esophageal injury

    Pulmonary contusion


    CLOSED CHEST INJURY
    n Closed (Blunt) – Falls, automobile crashes, direct blows to
    the chest
    u Force distributed over large area
    OPEN CHEST INJURY
    n Open (Penetrating) –
    Knife, GSW, ice
    picks, broken glass,
    nails
    u Force distributed

    over a small area


    Blunt Trauma
    Penetrating Trauma
    Pneumothorax
    n Blunt or penetrating trauma
    n Chest wall penetrated and air flows into the
    thoracic cavity around the lungs
    n Visceral and parietal pleura – air in pleural
    space collapses the lung
    n No penetration possible (broken rib), lung
    laceration - most common
    Pneumothorax
    Pneumothorax RX
    n Oxygen
    n Reassessment (tension pneumothorax
    possible)
    n Transport
    Sucking Chest Wound
    n Penetrating trauma
    n An open chest wound that sucks air into the
    wound; a noticeable sucking sound may be heard.
    u Additional air being sucked into cavity

    u Trapped air

    n Cover with gloved hand, or occlusive dressing


    (tape 3 sides)
    n Life Threat
    Sucking Chest Wound
    Tension Pneumothorax
    n Blunt or penetrating
    n When air builds up collapsing one or both
    lungs
    u Can compresses large vessels and heart
    n High flow oxygen
    n Reassessment
    n Rapid transport
    n Open sucking wound? Occlusive dressing –
    3 sides taped
    Rib Fractures

    n Pain
    n Most commonly blunt trauma
    n Most commonly injured
    n Reduced chest excursion – limits ventilation
    n Consider pulmonary and/or myocardial contusions
    n Consider pneumo/hemothorax
    Rib Fractures S/S
    n Dyspnea
    n Shallow respirations
    n Guarding (self splinting)
    n Painful respirations
    n Tender, unstable ribs
    Rib Fractures RX
    n Oxygen
    n Splint?
    n Reassessment
    n Transport
    n Major force involved
    n Two or more adjacent ribs are broken in two or more
    places
    n Unattached segment (flail segment)
    n Paradoxical movement (opposite movement of the rest of
    the chest)
    n Consider underlying injuries
    n Stabilize with hand initially, splint later
    n Life Threat
    Flail Segment S/S
    n Tenderness, unstable segment
    n Dyspnea
    n Shallow respirations
    n Guarding (self splinting)
    n Painful respirations
    n Paradoxical movement
    n Shock
    Flail Segment R/X
    n Provide high flow oxygen
    n Assist ventilations, if required
    n Stabilize flail segment (hand then bulky
    dressings)
    n Reassessment – Consider underlying
    injuries
    n Rapid Transport
    n Penetrating and blunt trauma
    n Rapid accumulation of blood in the chest
    (greater than 1500 ml)
    n Chest cavity can hold entire blood content
    n Cyanosis
    n Flat neck veins
    n Respiratory distress
    n Shock
    n Cold clammy skin
    n Breath sounds absent, hypo resonant
    Hemothorax RX
    n High flow oxygen
    n Ventilate, as needed
    n Rapid assessment
    n Reassessment
    n Rapid Transport
    Traumatic Asphyxia
    n Severe crush injury (blunt force) to the
    chest
    n Compression of the superior vena cava
    n Petechiae present
    n Cerebral edema
    n Head and neck swelling (tongue and lips)
    n Conjunctival hemorrhage
    Traumatic Asphyxia S/S
    n Swollen tongue, lips
    n Bloodshot eyes
    n Protruding eyes
    n Chest trauma (blunt force)
    Traumatic Asphyxia RX
    n CPR
    n CABC
    n High flow oxygen
    n Ventilate
    n Rapid transport
    Pericardial Tamponade
    n Penetrating trauma common
    n Blood filling the pericardial sack
    n 15 ml – 20 ml of fluid removal may be life
    saving
    Pericardial Tamponade S/S
    n Beck’s Triad
    u Distended neck veins

    u Muffled heart sounds

    u Hypotension

    n Tachycardia
    n Narrowed pulse pressure
    n Trachea midline
    n Normal breath sounds
    Pericardial Tamponade RX
    n High flow oxygen
    n Ventilate, as needed
    n Rapid transport
    n Reassessment
    n Stabilize with dressings, build up around object
    n Do not remove
    Relevant Chest Trauma
    SAMPLE History
    n GSW
    u Caliber, distance, number of shots, angle

    n Stab Wounds
    u Length of blade, type of blade
    (smooth/serrated), sex of the stabber
    n Falls
    u Height, surface landed on, body part
    landed on
    Assessment Techniques
    Page 954 & 956

    n Inspection (observation) – DCAP BTLS


    n Palpation (touch) – Instability
    n Percussion (sound waves) – Striking an
    object and listening to the sound made
    n Auscultation (listening) – Stethoscope;
    breath sounds, heart tones
    Palpation
    Auscultation
    Assessment Techniques
    n Vital signs
    u BP

    u Pulse

    u Respirations

    u Body Temperature
    MOI Considerations
    n Page 217– “Scene Size- up” section
    u Automobile crash – steering wheel

    u Sports accident

    u Fall

    u GSW

    u Fight

    u Crush injury

    u Explosion
    n Pneumothorax (tension too)
    n Flail chest
    n Hemothorax
    n Sucking chest wound
    n Traumatic asphyxia
    n Pericardial tamponade
    Terms

    Asymmetrical chest wall movement that


    lessens respiratory efficiency
    Terms
    Terms
    A dressing that can form an airtight seal
    over a wound
    Terms

    The difference between the systolic and


    diastolic blood pressures. Narrowing seen
    with pericardial tamponade.
    Terms

    Presence of air in the subcutaneous tissue;


    the resulting crackling sensation or sound
    Tension Pneumothorax
    page 945

    n Build up of air and pressure in the thoracic


    cavity of the injured lung is so severe that it
    places pressure on the uninjured lung.
    n Results in compression of the heart, large
    vessels, and the uninjured lung.
    n
    BAD STUFF
    BAD STUFF
    QUESTIONS ?

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