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Flashcards in Chest & Abdominal Trauma Deck (50)
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Chest Injuries: • Blunt trauma

– Can fracture ribs, sternum, and costal (rib) cartilages


Chest Injuries: • Compression

– Occurs when severe blunt trauma causes the chest to rapidly compress


Chest Injuries: • Penetrating objects

– Bullets, knives, pieces of metal or glass, steel rods, pipes, other objects
– Can damage internal organs and impair respiration


Chest Injuries: • Closed Chest Injuries

Flail Chest exhibits paradoxical motion


Assessment: Flail Chest

• Mechanism of injury
• Difficulty breathing/hypoxia
• Chest wall muscle contraction


Treatment: Flail Chest

• Primary assessment for life threats
• Administer oxygen
• Use bulky dressing to stabilize flail segment
• Monitor patient for respiratory rate and depth
– Assist ventilations if too shallow


Open Chest Injuries

• Difficult to tell what is injured from entrance wound
• Assume all wounds are life-threatening
• Open wounds allow air into chest
– Sets imbalance in pressure
– Causes lung to collapse


Assessment: Open Chest Wound

• “Sucking chest wound”
• Direct entrance wound to chest
• May or may not be a sucking sound
• May be gasping for air


Treatment: Open Chest Wounds

• Maintain open airway
• Seal wound
• Occlusive dressing
• Administer oxygen
• Treat for shock
• Immediate transport
• Consider ALS


Think About It: Chest & Abdominal Trauma

• Does the patient’s chest injury need to be
treated during the primary assessment?
• Does the open chest injury require an occlusive dressing?
• Does the patient’s injury necessitate immediate transport to a trauma center?


Injuries Within the Chest Cavity


Create a flutter valve


Traumatic Asphyxia

• Sudden compression of chest forcing blood out of organs and rupturing blood vessels
• Neck and face are a darker color than rest of the body
• May cause bulging eyes, distended neck veins, broken blood vessels in face


Cardiac Tamponade

• Direct injury to heart causing blood to flow into the pericardial sac around the heart
• Pericardium is a tough sac that rarely leaks
• Increased pressure on heart so chambers cannot fill
• Blood backs up into veins
• Usually a result of penetrating trauma
• Distended neck veins
• Shock and narrowed pulse pressure


Aortic Injury

• Aorta is the largest blood vessel in the body
• Penetrating trauma can cause direct damage
• Blunt trauma can sever or tear the aorta
• Damage can cause high-pressure bleeding; often fatal
• Patient complains of pain in chest, abdomen, or back
• Signs of shock
• Differences in blood pressure between right and left arms


Commotio Cordis

• Uncommon condition
• Trauma to chest when heart is vulnerable • Ventricular fibrillation (VF)
• Treat like VF patient: CPR, defibrillation


Abdominal Injuries

• Can be open or closed
• Internal bleeding can be severe if organs or blood vessels are lacerated or ruptured
• Serious, painful reactions if hollow organs rupture
• Evisceration may occur


Assessment: Abdominal Injuries

• Pain, initially mild but rapidly becoming intolerable as bleeding worsens
• Nausea
• Weakness
• Thirst
• Indications of blunt trauma to chest, abdomen, or pelvis
• Coughing up or vomiting blood
• Rigid and/or distended abdomen


Treatment: Abdominal Injuries

• Carefully monitor airway in presence of vomiting
• Place patient on back with knees flexed to reduce tension on abdominal muscles
• Administer oxygen
• Treat for shock
• If allowed, utilize pneumatic anti-shock garments (PASG)
• Nothing to patient by mouth
• Continuously monitor vital signs


Treatment: Evisceration

• Do not touch or replace eviscerated organs
• Apply sterile dressing moistened with sterile saline over wound site
• For large evisceration, maintain warmth by placing layers of bulky dressing over occlusive dressing


Treatment: Impaled Object

• Do not remove
• Stabilize with bulky dressings bandaged in place
• Leave patient’s legs in position found to avoid muscular movement that may move impaled object


Chapter Review: Chest & Abdominal Trauma

• An open chest or abdominal wound is considered to be one that penetrates not only the skin but the chest and abdominal wall to expose internal organs.
• Open chest and abdominal wounds are life threatening.


Chapter Review: Chest & Abdominal Trauma

• A flail chest is characterized by
paradoxical motion.
• Seal an open chest wound with an occlusive dressing taped on three sides to make a one-way valve.
• Closed chest wounds are difficult to distinguish.


Chapter Review: Chest & Abdominal Trauma

• A patient who collapses in cardiac arrest after a force to the center of the chest should receive CPR.
• If a patient develops signs of tension pneumothorax, arrange immediately for ALS intercept.


Chapter Review: Chest & Abdominal Trauma

• When solid abdominal organs are injured, life threatening amounts of blood loss can occur.
• When hollow abdominal organs are injured, their contents spill into the abdominal cavity causing irritation.


Remember: Chest & Abdominal Trauma

• Blunt trauma, penetrating trauma, and compression are mechanisms that can injure the chest and abdomen.
• Open or closed pertains to the integrity of the chest or abdominal wall after injury.
• Seal open chest wounds to prevent air from entering the chest cavity.


Remember: Chest & Abdominal Trauma

• Closed chest and abdominal wounds bear a high risk for underlying organ system damage and internal bleeding. Use mechanism of injury and patient assessment to recognize the signs and symptoms of shock.


Remember: Chest & Abdominal Trauma

• EMTs should learn signs and symptoms, and treatment procedures for specific chest and abdominal injuries.


Questions to consider: Chest & Abdominal Trauma

• Is the patient’s breathing adequate, inadequate, or absent?
• Is the patient displaying signs of shock?
• Is there an open wound in the chest that needs to be sealed?


Questions to consider: Chest & Abdominal Trauma

• Is the patient displaying signs of a tension pneumothorax?
• Is there an open wound in the abdomen that needs to be dressed and covered?


Critical Thinking: Chest & Abdominal Trauma

• You are caring for a patient who was shot in the chest with a nail gun. You applied an occlusive dressing around the wound. The patient is suddenly deteriorating. He is having extreme difficulty breathing and his color has worsened.
• Breath sounds have become almost totally absent on the side with the impaled nail. What complication might you suspect is causing his worsening condition? How could this be corrected?