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Chest injury - definition

Trauma to the thoracic cavity leading to the impairment of respiratory function through the compromise of ventilation, oxygenation or circulation.
They can be open or closed.


Causes of chest injury

Blunt Trauma.
Penetrating Trauma.


Examples of chest injury

Fractured ribs.
Potentially life threatening:
Flail segment.
Simple Pneumothorax.
Open Pneumothroax.
Tension Pneumothorax.
Cardiac Tamponade.



Air is trapped between the visceral and parietal pleura.


Open/Sucking chest wound

Hole in the chest (intercostal muscle and parietal pleura). Air uses this pathway to fill the space between parietal and visceral pleura, due to negative pressure of the thoracic cavity whilst breathing in, instead or as well as, via the airway into the lung.


Tension Pneumothorax

A hole in the visceral pleura causing the space between it and the parietal pleura to fill with air. This causes a build up of pressure between the two pleura and the lung gets crushed.


Rib Fractures - info

Most common thoracic injury.
Normally caused by blunt trauma.
Ribs from 4-9 inclusive, are the most commonly fractured.


Rib Fractures - signs & symptoms

pleuritic chest wall pain.
Mild dyspnoea (DIB).
Chest wall tenderness.
Overlying soft tissue injury.
Crepitus (grating sound of # bone).
Splinted ventilatory effort.
Subcutaneous emphysema.
Leaning towards injured side.


Management of chest injuries.

DR-C(control external catastrophic haemorrhage)-ABCD assessment
Correct A&B problems.
Provide high flow O2.
Consider assisted ventilations.
Place patient in comfortable position, respecting mechanism of injury and treatment required.
Assist paramedic with IV pain relief if necessary.
Assist paramedic with 'Needle Thoracocentisis if indicated.
Undertake a, smooth, time critical transfer to nearest 'Major Trauma Centre'.
Provide pre-alert call via PD09.
Continue patient management on route.


Management - specific to open chest injury

Dress with chest seal.


Management - specific to impaled objects

Handle carefully! Secure object with dressings, if the object is pulsating, do NOT completely immobilise it, but allow it to pulsate.


Management - specific to flail segment injury

Do NOT immobilise --> time critical transfer.


Pelvic injury - signs and symptoms

Leg Position.
Blood Loss.


Management of Pelvic Injuries.

DR-C(control external catastrophic haemorrhage)-ABCD assessment.
Open maintain and protect airway.
High flow O2.
Apply pelvic splint directly to skin.
If after application of the splint the feet remain externally rotated, secure feet with a figure of 8 using a broad fold triangular bandage.
Assist paramedic with appropriate pain management.
Provide smooth transport to 'Major Trauma Centre' and pre-alert via PD09.


5 regions of your spine

Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae


Spinal Cord Injury (SCI) - signs and symptoms

Respiratory Pattern
No signs or symptoms at all


Abnormal Neurology Associated with SCI

Loss of sensation in the limbs.
Reduced or abnormal sensation in the trunk or in limbs.
Loss of movement in the limbs.
Sensation of burning in the trunk or limbs.
Sensation of electric shock in the trunk or limbs.
Sensation of 'pins & needles'.
Feeling "open/cut in two".


spinal injury - Management

DR-C(control external catastrophic haemorrhage)-ABCD assessment.
Open and maintain airway.
High flow O2 as per guidelines.
Apply manual immobilisation at earliest opportunity whilst initial assessment is undertaken.
Evaluate whether time critical or non time critical.


spinal injury - Management - time critical patient

Control the airway.
Immobilise the spine.
Transfer to the nearest suitable receiving hospital.
Provide a hospital alert message via PD09.
Continue patient management en-route.


spinal injury - Management - general principles

Through examination and history taking, define mechanism of injury:
One or more of these.
Look for symptoms of SCI


spinal injury - Management - conscious patient

Assess Motor, Sensory and Circulatory function in all 4 limbs: MSCx4.
Use light touch and response to pain.
Examine upper limbs and hands.
Examine lower limbs and feet.
Examine both sides.
(if non time critical perform a thorough secondary survey)
Apply standard immobilisation equipment (collar, head blocks, tape, straps and scoop or long board - only use long board where patient requires extrication).
Provide a smooth journey to hospital.
How long has the patient been immobilised?
Complete paperwork.


spinal injury - Management - don't forget..

Immobilise the spine until it is positively cleared.
Immobilise the spine of all unconscious blunt trauma victims.
If the neck is immobilised, the thoracic and lumbar spine also need to be immobilised.
Aspiration of vomit, pressure sores and raised intracranial pressure are major complications of immobilisation.


spinal injury immobilisation - Elderly patients

Pad for support as needed.
C/O breathing difficulties (especially when flat).
'Best possible approach'


spinal injury immobilisation - Consider skin care issues

Pressure sores and necrosis can develop very quickly.
Look for straps, rumpled clothing, blankets etc.
Ensure 'time on scoop' is monitored closely.


spinal injury - Oxygen

Secondary injury to the spinal cord may be caused by hypoxia and/or hypercarbia.
All patients with suspected major trauma (chest injury, pelvic fracture, SCI) require high levels of supplemental O2.
Administer the initial O2 dose until the vital signs are normal, then reduce the dose and aim for target saturation within the range of 94-98%.