DEALING WITH CHEST INJURIES

General Overview

Lung injury is a primary concern secondary to a blow to the chest wall.  Specific diagnosis is difficult, but signs and symptoms of dyspnea (difficulty breathing), especially at rest, should trigger an evacuation.  Lung injury can occur spontaneously and outdoor leaders should be attentive to sudden complaints of difficulty breathing.

Treatment for Chest Injuries

1. Place the patient in a position of comfort or on the injured side.
2. Stabilize any injuries. For a fractured rib sling and swathe or tape the affected side. For a flail segment splint with a bulky dressing.
3. For an open chest injury seal the wound with an occlusive dressing secured on three sides.
4. Administer high-flow/high-concentration oxygen if available. Support respirations if necessary.
5. Pain management. Avoid respiratory depressants (e.g. narcotics).
6. Periodically encourage the patient to breathe deeply.
7. Monitor for increasing Shortness of Breath (SOB) at rest and diminishing breath sounds.

Evacuation Guidelines for Chest Injuries

Evacuate Rapidly:

• Any patient with signs and symptoms of serious chest trauma or respiratory distress.
• Any patient exhibiting increasing shortness of breath, especially at rest.
• Any patient with diminished or abnormal lung sounds.

Evacuate:

• Any patient with a suspected rib or clavicle fracture.

References:

Emergency Medical Technician-Basic: National Standard Curriculum Module 5 Trauma.  22 June 1995.  National Highway Traffic Safety Administration United States Department of Transportation.  2 Dec 2004. <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>

“Thoracic Trauma.” PHTLS Basic and Advanced Prehospital Trauma Life Support. St. Louis, Missouri: Mosby, 2003.  Chapter 5.

Schimelpfenig, Tod and Linda Lindsey.  “Chest Injuries.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 7.

Specific Protocols for Wilderness EMS Chest Injury.  Version 1.2 May 19, 1994.  The Wilderness Emergency Medical Services Institute.  2 Dec. 2004.  <http://www.wemsi.org/specific.html>;

Tilton, Buck.  “Chest Injuries.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 10.

Wilkerson, James A.  “ Chest Injuries.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 11.