Chest Injuries

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Section 6 - TRAUMA

6.04 CHEST INJURIES

INITIAL TRAUMA CARE, (2.02)


SUCKING CHESTWOUND / OPEN PNEUMOTHORAX:

  • Apply occlusive dressing taped on three sides to create flutter valve.
  • If patient deteriorates, remove dressing temporarily to allow air to escape.


TENSION PNEUMOTHORAX:

  • Suspect when patient presents with severe respiratory distress hypotension, distended neck veins, absent breath sounds on the involved side and / or tracheal deviation. Also suspect when marked resistance is met while assisting respirations.
  • PLEURAL DECOMPRESSION on affected side.

NOTE: In the event of Traumatic Arrest consistent with chest injuries, consider performing bilateral Pleural Decompression.


PERICARDIAL TAMPONADE:

  • Suspect when patient presents with hypotension, distended neck veins, muffled heart tones and good breath sounds bilaterally, or penetrating chest injuries between the right midclavicular line and the left midaxillary line.
  • Fluid boluses in 200 - 300 ml increments while en route.


FLAIL SEGMENT:

  • Restrict flail segment movement to involved area of chest, assess for ventilatory compromise.
  • If patient deteriorates, assess for possible pneumothorax.