Course Library

Thoracic Trauma

Information Covered:

1. Incidence of Chest Trauma
   1. Morbidity
   2. Mortality
2. Mechanism of Injury for Chest Trauma
   1. Blunt
   2. Penetrating
   3. Energy and Injury
3. Anatomy of the Chest
   1. Skin
   2. Muscles
   3. Bones
   4. Trachea
   5. Bronchi
   6. Lungs
   7. Vessels
   8. Heart
   9. Esophagus
   10. Mediastinum
4. Physiology
   1. Role of the Chest in Systemic Oxygenation
      1. Musculoskeletal structure
      2. Intercostal muscle
      3. Diaphragm
      4. Accessory muscle
      5. Changes in intrathoracic pressure
   2. Ventilation
      1. Gas exchange depends on
         1. Normal inspiration
            1. active process
            2. normal chest rise
            3. negative pressure in chest allows air to flow in
         2. Normal expiration – passive process
      2. Chest wall movement – intact chest wall
      3. Minute volume – volume of air exchanged between lungs and environment per minute
5. Pathophysiology of Chest Trauma
   1. Impaired Cardiac Output Related to
      1. Trauma that affects the heart
         1. Heart can’t refill with blood
         2. Blood return to the heart is blocked
      2. Blood loss (external and internal)
   2. Impaired Ventilation
      1. Collapse of lung
      2. Multiple rib fractures
   3. Impaired Gas Exchange
      1. Blood in lungs
      2. Bruising of lung tissue
6. General Assessment Findings
   1. Vital Signs
      1. Blood pressure
      2. Pulse
         1. Increases initially if hypoxia or shock
         2. Decreases when patient near arrest from shock or hypoxia
      3. Respiratory rate and effort – respiratory distress
   2. Skin – Color, Temperature, Moisture
   3. Head, Neck, Chest, and Abdomen
      1. Jugular vein distension
      2. Paradoxical movement
   4. Level of Consciousness
   5. Medical History
      1. Medications
      2. Respiratory/cardiovascular diseases
   6. Physical Exam
      1. Inspection
      2. Auscultation – breath sounds present or absent
      3. Palpation
   7. Associated Injuries
   8. Blunt Injury
   9. Penetrating Injury
7. General Management
   1. Airway and Ventilation
      1. Occlusion of open wounds
      2. Positive pressure ventilation – to support flail chest
   2. Circulation
8. Blunt Trauma or Closed Chest Injury
   1. Closed Chest Injury
      1. Specific injuries
         1. Rib fractures
         2. Flail segment – stabilizing a flail is contraindicated
         3. Sternal fracture – consider underlying injury
         4. Clavicle fracture
         5. Commotio Cordis
9. Open Chest Injury
   1. Mechanism of Injury
      1. Penetrating injury from weapons
      2. Penetrating injury secondary to blunt chest wall trauma
      3. Specific injuries
         1. Lung Injury
         2. Air in pleural space causes lung to collapse (pneumothorax)
            1. closed
            2. open (sucking chest wound)
         3. Increasing amounts of air in space causing pressure on vessels and heart (tension pneumothorax)
         4. Blood in chest due to injury (hemothorax)
         5. Signs and symptoms of lung injury
            1. oxygenation changes due to open chest injuries
            2. decreased or absent lung sounds due to open chest injuries
         6. Assessment of lung injury – presence or absence of lung sounds
         7. Management – apply non-porous (occlusive) dressing
         8. Myocardial injury
         9. 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)
         10. Signs and symptoms of heart injury
             1. irregular pulse
             2. chest pain
             3. hypo-perfusion
         11. Assessment
         12. Management

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.