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This topic covers the identification and management of chest injuries.
Chest Injuries – Introduction
The chest contains two of the body's most important organs, the heart and the lungs.
An injury to this area could be life threatening if the protective rib cage is damaged.
Not counting bruising and muscular aches, there are three main types of chest injury
· Fractured ribs
· Flail Chest
· Penetrating Chest Wound
These injuries are usually caused by blows, falls, crushing by heavy objects or interference by others e.g. gunshots, stabbing or explosions.
Fractured Ribs
A simple rib fracture is rarely life-threatening but is painful. The greatest risk associated with fractured ribs is the possibility that the sharp, broken ends of the bone can cut or puncture the lungs or heart.
The casualty must be kept still and protected from further blows or sudden movements that might cause the broken rib ends to move.
Flail Chest
Flail chest occurs when a section of rib cage is broken away from the rest of the ribs.
This section ‘floats’ in place and as the casualty breathes it moves in the opposite way to the rest of the chest.
This is known as "paradoxical breathing".
Penetrating Chest Wound
A penetrating chest wound is an open wound, through which air can be sucked in and out of the chest cavity. This type of injury can lead to the collapse of a lung and pooling of blood in the area.
Penetrating chest wounds can be any size depending on the object that has caused the damage.
They may involve fractured ribs or punctured lungs.
Chest Injuries – Signs and Symptoms
The following list is an example of the signs and symptoms relating to injuries sustained in the chest area.
A flail chest has no visible wound. These can be caused by a significant blow to the chest such as: in a car accident. A person suffering from a flail chest will experience some chest pain and difficulty in breathing and shortness of the breath, they will more then likely be gasping for air. You will notice a blue colouring of the mouth, nailbeds and skin. The casualty may have a loose part moving in the direction opposite to that of normal breathing and casualty may loose consciousness
Fractured Ribs have no visible wound. They can be caused by a direct blow such as being hit by a heavy object. The casualty will experience chest pain and will be taking short, rapid breaths. They will also experience a tenderness at the site of the injury.
A Penetrating Chest Wound is generally an open wound. It is caused by an object piercing the body which could be caused by a car accident or knife attack. The casualty will experience pain at the site of the wound and will experience pain and difficulty in breathing. You may hear the sound of air being sucked into the chest. Blood stained bubbles will be forming around the wound. The casualty may loose consciousness. A casualty with a penetrating chest wound may also have fractured ribs or a flail chest.
Management
Management of a Flail Chest:
1. Follow DRABCD
2. If casualty conscious, place casualty in a comfortable position (normally half-sitting, leaning to the injured side)
3. If casualty unconscious, turn to the injured side, in a recovery position.
4. Loosen tight clothing
5. Place a large bulky dressing over the loose area with a firm bandage.
6. Call 000 for an ambulance
Management of a Penetrating Chest Wound:
1. Follow DRABCD
2. Place casualty in whatever position makes breathing easiest
3. Cover the wound – use the casualty’s or your own gloved hand.
4. Cover wound with a dressing, such as plastic sheet, bag, aluminium foil or sterile dressing.
5. Seal with tape on three sides (not bottom), to allow fluid to escape.
6. Call 000 for an ambulance
Management of Fractured Ribs:
1. Follow DRABCD
2. Place casualty in comfortable position
3. Encourage the casualty to breathe with short breaths
4. Gently place ample padding over the injured area
5. Apply one or two broad bandages, securing arm and padding to chest on injured side.
6. Tie bandages in front on uninjured side
7. Immobilise the arm using a St John sling or collar and cuff sling
8. Call 000 for an ambulance
Chest Injuries – Summary
Chest injuries are painful, complicated and potentially life threatening.
As a first aider you must concentrate on:
· Ensuring that the casualty's breathing and circulation are maintained,
· The injured parts are immobilised and
· The casualty is kept as comfortable as possible.
The most comfortable position, which will assist breathing, is half-sitting, leaning to the injured side.
You should continue to monitor the casualty's condition until medical aid arrives. You should also treat a casualty with chest injuries for shock.
For more information on Chest Injures, see Australian First Aid chapter 7.
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