Thoracic Trauma
Information Covered:
- Incidence of Chest Trauma
- Morbidity
- Mortality
- Mechanism of Injury for Chest Trauma
- Blunt
- Penetrating
- Energy and Injury
- Anatomy of the Chest
- Skin
- Muscles
- Bones
- Trachea
- Bronchi
- Lungs
- Vessels
- Heart
- Esophagus
- Mediastinum
- Physiology
- Role of the Chest in Systemic Oxygenation
- Musculoskeletal structure
- Intercostal muscle
- Diaphragm
- Accessory muscle
- Changes in intrathoracic pressure
- Ventilation
- Gas exchange depends on
- Normal inspiration
- active process
- normal chest rise
- negative pressure in chest allows air to flow in
- Normal expiration – passive process
- Normal inspiration
- Chest wall movement – intact chest wall
- Minute volume – volume of air exchanged between lungs and environment per minute
- Gas exchange depends on
- Role of the Chest in Systemic Oxygenation
- Pathophysiology of Chest Trauma
- Impaired Cardiac Output Related to
- Trauma that affects the heart
- Heart can’t refill with blood
- Blood return to the heart is blocked
- Blood loss (external and internal)
- Trauma that affects the heart
- Impaired Ventilation
- Collapse of lung
- Multiple rib fractures
- Impaired Gas Exchange
- Blood in lungs
- Bruising of lung tissue
- Impaired Cardiac Output Related to
- General Assessment Findings
- Vital Signs
- Blood pressure
- Pulse
- Increases initially if hypoxia or shock
- Decreases when patient near arrest from shock or hypoxia
- Respiratory rate and effort – respiratory distress
- Skin – Color, Temperature, Moisture
- Head, Neck, Chest, and Abdomen
- Jugular vein distension
- Paradoxical movement
- Level of Consciousness
- Medical History
- Medications
- Respiratory/cardiovascular diseases
- Physical Exam
- Inspection
- Auscultation – breath sounds present or absent
- Palpation
- Associated Injuries
- Blunt Injury
- Penetrating Injury
- Vital Signs
- General Management
- Airway and Ventilation
- Occlusion of open wounds
- Positive pressure ventilation – to support flail chest
- Circulation
- Airway and Ventilation
- Blunt Trauma or Closed Chest Injury
- Closed Chest Injury
- Specific injuries
- Rib fractures
- Flail segment – stabilizing a flail is contraindicated
- Sternal fracture – consider underlying injury
- Clavicle fracture
- Commotio Cordis
- Specific injuries
- Closed Chest Injury
- Open Chest Injury
- Mechanism of Injury
- Penetrating injury from weapons
- Penetrating injury secondary to blunt chest wall trauma
- Specific injuries
- Lung Injury
- Air in pleural space causes lung to collapse (pneumothorax)
- closed
- open (sucking chest wound)
- Increasing amounts of air in space causing pressure on vessels and heart (tension pneumothorax)
- Blood in chest due to injury (hemothorax)
- Signs and symptoms of lung injury
- oxygenation changes due to open chest injuries
- decreased or absent lung sounds due to open chest injuries
- Assessment of lung injury – presence or absence of lung sounds
- Management – apply non-porous (occlusive) dressing
- Myocardial injury
- Penetrating – effect on pumping action of the heart and blood loss with blood in the sac surrounding the heart restricting heart’s ability to pump (pericardial tamponade)
- Signs and symptoms of heart injury
- irregular pulse
- chest pain
- hypo-perfusion
- Assessment
- Management
- Mechanism of Injury
Content Creator: Dan Livengood
CAPCE Course Number: 20-EMTP-F3-2205
NJ Course Number: 141069
Total CE Hours: 1
Level: Basic
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.