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Chest Trauma

Lesson Four

► Penetrating chest injuries may result from:

 IEDs

 Gunshot wounds

 Schrapnel injuries

 Stab wounds

 Stick
Anatomy of the Thorax

Assess the casualty
► Identify signs and symptoms:

 Airway

 Breathing

 Circulation
Signs indicative of chest
► Shock

► Cyanosis (bluish tint of lips, mouth, fingertips or nails)

► Dyspnea (shortness of breathing or difficulty breathing)

► Hemoptysis (coughing up blood)

► Open wounds (sucking or hissing sounds from the wound)

► Frothy blood around the wound

► Chest not rising normally when casualty inhales

► Pain in shoulder or chest that increases with breath

Flail Chest
► Two or more adjacent ribs are fractured in at
least two places or separation of sternum
from ribs
Assess Respirations

► Respiratory rate and effort:

 Tachypnea

 Bradypnia

 Labored

 Retractions
Locate and Expose Open
Chest Wound
 Cut, Remove, or tear clothing over wound
 Do not remove stuck clothing
 Do not try to clean or remove objects from

 Check for entry and exit wound (look and


 If entry and exit (same side), apply flutter-

valve seal (three taped sides) to the wound on
Assessing The Chest

 Compare both
sides of the
chest at the
same time when
assessing for
Open Chest Wound
Open Chest Wound
Seal and Dress Open Chest
 Open field dressing wrapper

 Have casualty exhale

 Place wrapper over wound
 Tape wrapper in place
 Apply field dressing
 Secure dressing (tie directly
over the wound)
Open Chest Wound

 Position casualty on side with injured

side next
to ground
 Allow casualty to sit up if it is easier
 Seek medical help
 Monitor breathing
 Treat for shock
 Evacuate
Impaled Object
Impaled Object
► Ifthe casualty is unconscious or cannot
hold his breath, place the airtight
material over the wound after the chest
falls but before it rises.

► Ifthe casualty is conscious and wants to

sit upright, allow him to sit with his back
against a tree or other supporting object.
Open Pneumothorax
Open Pneumothorax
Open Pneumothorax

Petroleum Gauze
can also be used to
seal a sucking
chest wound.
Tension Pneumothorax

►Airenters thoracic space but

cannot escape, pressure builds
and further collapses the lung
and forces mediastinum and
heart away from effected lung.
May also compromise good lung
and major vessels to the heart.
Tension Pneumothorax
►Tension pneumothorax is the
second leading cause of preventable
death on the battlefield.

► Consider progressive, severe

respiratory distress resulting from
unilateral chest trauma to represent a
tension pneumothorax and
Tension Pneumothorax

Air pushes over heart

and collapses lung

lung from
Heart compressed not able
to pump well
Tension Pneumothorax
 Anxiety, agitation, apprehension

 Increasing dyspnea with cyanosis

 Tachypnea

 Tracheal shift (late sign)

 Distended neck veins

 Hypotension - loss of radial pulse

 Cool clammy skin, patient deteriorates rapidly

 These signs are hard to detect in a combat environment

Needle Chest
► Indications

 Penetrating chest wound with

progressive respiratory distress
► Required Materials
 10 to 14 gauge I.V. needle w/catheter
2.5-3 in long
 Betadine or Alcohol Prep Pads
 1/2” Tape
Needle Chest

A needle chest decompression is

performed ONLY if the casualty has
a penetrating wound to the chest and
increased difficulty breathing.
Performing a Needle
Chest Decompression
Obtain a large bore (14 ga) needle
and catheter unit and strip of tape
from your aid bag.
Tension Pneumothorax
► Burp the wound:

 If no capability of NCD exists and the

patient continues to have progressive
respiratory distress, remove the occlusive
dressing and stick a gloved finger into the
open wound and burp the wound.
Needle Chest
► Review anatomy of the chest and identify
the following anatomical landmarks on
the side of the open wound & tension
 Mid-clavicular line
 Second intercostal space
 superior edge of the 3rd rib
Needle Chest
► Steps for performing the procedure:
 Casualty may be lying flat, sitting, etc. Casualty
positioning isn’t dependant on any specific position
for this procedure

 Site preparation may be accomplished by using

either alcohol and/or betadine prep pads to disinfect
the skin

 Using your index finger, trace the mid-clavicular line,

then identify the second intercostal space (between
the second and third rib) on the side of the tension
Needle Chest
► Steps for performing procedure:
 Insert the needle perpendicular to the chest
wall, directly over the top of the third rib until
a palpable pop is felt, followed immediately
by a hissing or air escaping from the chest

 A rush of air confirms the diagnosis and

rapidly improves the patient’s condition
Performing a Needle
Chest Decompression
Firmly insert the needle into the skin at a
90 degree angle.
Needle Chest

Laceration of the intercostal

vessels or nerve may cause
hemorrhage or nerve damage