Interactive Ready for Review: Interactivities

There are two types of chest injuries: penetrating, or open, injuries and blunt, or closed, injuries.

In trauma, a blow to the chest may fracture the ribs, the sternum, or whole areas of the chest wall. Compression of these structures creates other problems, including contusions of the lungs and the heart and possible damage to the aorta. Even if the skin and chest wall are intact, the contents of the thorax may be injured.

A sucking chest wound can be the result of an , in which air entering through the wound accumulates in the pleural space, causing the lung to collapse.

You should seal a sucking chest wound with an occlusive dressing, either taping it down on all four sides or creating a flutter valve by sealing only three sides. Sealing all four sides may create a , in which air leaking from a lacerated lung is unable to escape and the lung collapses. Eventually, this air may push the mediastinum into the opposite hemithorax and prevent blood from returning to the heart. Cardiac arrest may result. If tension begins to develop, simply "burp" the dressing to allow trapped air to escape.

A tension pneumothorax can also occur in a closed, blunt injury of the chest in which a fractured rib lacerates the surface of the lung or as a result of . Look for increasing respiratory distress, shock, jugular vein distention, and decreased breath sounds on the affected side. Remember, contralateral tracheal deviation is a late sign.

The accumulation of blood in the pleural space is called a ; the collection of both blood and air is called a .

Multiple rib fractures, with or without a fracture of the sternum, often result in a condition called , in which a portion of the chest wall is detached from the thoracic cage and moves paradoxically during respiration.

A flail chest causes very painful breathing and requires respiratory support and supplemental high-flow oxygen. It may help to immobilize the flail segment with a bulky dressing. Remember to never tape around the entire circumference of the thorax because this may impede breathing. Do not use heavy objects such as sandbags.

Other thoracic injuries include rupture or dissection of the aorta, diaphragmatic injuries, contusions of the lungs and heart, and traumatic asphyxia, in which a sudden, severe compression of the chest produces a rapid increase in intrathoracic pressure. Signs of this condition include distended neck veins, cyanosis to the face, bulging eyes, and hemorrhage in the sclera. Provide ventilatory support, monitor vital signs, and provide immediate transport.

In , blood collects in the pericardium, preventing the heart from filling during the diastolic phase and eventually causing cardiac arrest. Signs include a weak pulse and the Beck triad: narrowing pulse pressure, distended neck veins, and muffled heart sounds. Definitive treatment includes a pericardiocentesis performed in the hospital. Here as well, you should provide vigorous respiratory support and immediate transport.

Laceration of the large blood vessels in the chest can cause a fatal hemorrhage. Suspect such a wound in any patient with a chest wound who shows signs of shock, even if you see little blood; it may be collecting within the chest cavity. The thorax will sound dull (hyporessonant) to percussion. This person needs supplemental high-flow oxygen with possible positive-pressure ventilation, immediate transport, and CPR if cardiac arrest develops.

Intravenous fluid therapy during thoracic trauma should be closely monitored and administered according to local protocol. The goal is to maintain adequate perfusion without causing a marked increase in blood pressure. Early recognition and prompt transport to the closest, most appropriate facility are vital to patient survival in thoracic trauma.

Any injury to the thoracic cavity may disrupt normal cardiac function. Always monitor ECG readings and treat the patient based on ACLS and local protocols. Consider aggressive airway management, including endotracheal intubation when indicated.

A needle thoracostomy is the treatment of choice for a tension pneumothorax. Consider analgesics for pain relief according to local protocol, and consider sodium bicarbonate to offset metabolic acidosis in traumatic asphyxia. Follow local protocols or contact medical control as needed.