Patient Assessment and Chest Injuries

Perform scene size-up to identify the number of patients and request additional resources as needed
Primary survey focuses on forming a general impression, noting the patient's level of consciousness, and performing a rapid exam for obvious injuries
Examine the patient for signs of life threats, such as difficulty breathing, noisy or irregular breathing, and accessory muscle use

Rib fractures occur most often in older patients due to brittle bones
Fractured ribs can lacerate the lung surface, leading to subcutaneous emphysema
Multiple rib fractures can lead to hypoventilation, inadequate cough, and pneumonia
Posterior rib fractures suggest severe trauma and potential for other life-threatening injuries

Occurs when a segment of the chest wall is detached from the rest of the thoracic cage
Often caused by MVCs, falls, or industrial accidents
Mortality rate increases with advanced age, multiple associated injuries, shock, and head injuries

Isolated sternal fractures have a mortality rate that rises with additional injuries and age
Clavicle fracture is one of the most commonly fractured bones in the body

Cardiac tamponade (paracardial tamponade) occurs when blood or fluid collects in the pericardium
Classic signs of cardiac tamponade include narrowing pulse pressure, JVD, and muffled heart tones
Treatment involves assessing and managing ABCs, initiating large-bore IV access, and providing rapid fluid bolus

Hemothorax occurs when blood accumulates in the space between the parietal and visceral pleura
Massive hemothorax is considered accumulation of more than 1,500 mL of blood in the plural space
Pulmonary contusion is the most common injury from blunt thoracic trauma and is often associated with rib fractures
Traumatic aortic disruption is a rupture of the aorta and occurs most often in blunt trauma
Diaphragmatic injury is life-threatening and can cause bowel obstruction, strangulation, and cardiac and respiratory compromise

Manage ABCs and evaluate the patient for other injuries
Use monitoring devices to obtain vital signs
Provide oxygen and administer fluid bolus as needed
Reassess the patient frequently to detect changes in condition### Traumatic Asphyxia
Caused by sudden, severe compression injury to the chest, resulting in rapid increase in thoracic pressure
Characterized by chest compression, blood backing up into the head and neck, jugular veins engorgement, and capillaries rupture
Symptoms include:
- Distended neck veins
- Cyanosis in the face, upper neck, and extremities above the level of compression
- Swelling and sinosis of the tongue and lips
- Ocular hemorrhage (mild or dramatic)
Skin below the area of compression remains normal in color
Hypotension occurs when pressure is released
Key treatment points:
- Rapid recognition and transport
- Treat symptoms
- Take cervical spinal precautions
- Obtain IV access with two large bore IVs

Identify the number of patients and request additional resources as needed through scene size-up
Focus on forming a general impression, noting the patient's level of consciousness, and performing a rapid exam for obvious injuries during primary survey
Examine the patient for signs of life threats, such as difficulty breathing, noisy or irregular breathing, and accessory muscle use

Older patients are more prone to rib fractures due to brittle bones
Fractured ribs can cause subcutaneous emphysema by lacerating the lung surface
Multiple rib fractures can lead to complications like hypoventilation, inadequate cough, and pneumonia
Posterior rib fractures are often associated with severe trauma and potential for other life-threatening injuries

Flail chest occurs when a segment of the chest wall is detached from the rest of the thoracic cage
Common causes of flail chest include MVCs, falls, and industrial accidents
Mortality rate increases with advanced age, multiple associated injuries, shock, and head injuries

Isolated sternal fractures have a mortality rate that rises with additional injuries and age
Clavicle fracture is one of the most commonly fractured bones in the body

Cardiac tamponade occurs when blood or fluid collects in the pericardium
Classic signs of cardiac tamponade include narrowing pulse pressure, JVD, and muffled heart tones
Treatment involves assessing and managing ABCs, initiating large-bore IV access, and providing rapid fluid bolus

Hemothorax occurs when blood accumulates in the space between the parietal and visceral pleura
Massive hemothorax is considered when more than 1,500 mL of blood accumulates in the plural space
Pulmonary contusion is the most common injury from blunt thoracic trauma and is often associated with rib fractures
Traumatic aortic disruption is a rupture of the aorta and occurs most often in blunt trauma
Diaphragmatic injury is life-threatening and can cause bowel obstruction, strangulation, and cardiac and respiratory compromise

Caused by sudden, severe compression injury to the chest, resulting in rapid increase in thoracic pressure
Characterized by chest compression, blood backing up into the head and neck, jugular veins engorgement, and capillaries rupture
Symptoms include:
- Distended neck veins
- Cyanosis in the face, upper neck, and extremities above the level of compression
- Swelling and sinosis of the tongue and lips
- Ocular hemorrhage (mild or dramatic)
Skin below the area of compression remains normal in color
Hypotension occurs when pressure is released
Key treatment points:
- Rapid recognition and transport
- Treat symptoms
- Take cervical spinal precautions
- Obtain IV access with two large bore IVs