MSTC, FT LEWIS WA MSTC, FT LEWIS WA Chest Trauma Chest Trauma Lesson Four Lesson Four
MSTC, FT LEWIS WAMSTC, FT LEWIS WA
Chest TraumaChest Trauma
Lesson FourLesson Four
► Penetrating chest injuries may result from:Penetrating chest injuries may result from:
IEDsIEDs
Gunshot woundsGunshot wounds
Schrapnel injuriesSchrapnel injuries
Stab woundsStab wounds
StickStick
IntroductionIntroduction
Anatomy of the ThoraxAnatomy of the Thorax
►TracheaTrachea►LungsLungs►BronchiBronchi►MediastinuMediastinu
mm
►HeartHeart
Assess the casualtyAssess the casualty
► Identify signs and symptoms:Identify signs and symptoms:
AirwayAirway
BreathingBreathing
CirculationCirculation
Signs indicative of chest Signs indicative of chest injuryinjury
► ShockShock
► Cyanosis (bluish tint of lips, mouth, fingertips or nails)Cyanosis (bluish tint of lips, mouth, fingertips or nails)
► Dyspnea (shortness of breathing or difficulty breathing)Dyspnea (shortness of breathing or difficulty breathing)
► Hemoptysis (coughing up blood)Hemoptysis (coughing up blood)
► Open wounds (sucking or hissing sounds from the wound)Open wounds (sucking or hissing sounds from the wound)
► Frothy blood around the woundFrothy blood around the wound
► Chest not rising normally when casualty inhalesChest not rising normally when casualty inhales
► Pain in shoulder or chest that increases with breathPain in shoulder or chest that increases with breath
► Two or more adjacent ribs are fractured in at Two or more adjacent ribs are fractured in at least two places or separation of sternum least two places or separation of sternum from ribsfrom ribs
Flail ChestFlail Chest
CyanosisCyanosis
Assess RespirationsAssess Respirations
► Respiratory rate and effort:Respiratory rate and effort:
TachypneaTachypnea
BradypniaBradypnia
LaboredLabored
RetractionsRetractions
Locate and Expose Open Locate and Expose Open Chest WoundChest Wound
Cut, Remove, or tear clothing over woundCut, Remove, or tear clothing over wound
Do not remove stuck clothingDo not remove stuck clothing
Do not try to clean or remove objects fromDo not try to clean or remove objects from woundwound
Check for entry and exit wound (look and Check for entry and exit wound (look and feel)feel)
If entry and exit (same side), apply flutter-If entry and exit (same side), apply flutter-valve seal (three taped sides) to the wound on valve seal (three taped sides) to the wound on the front and a full seal (all four sides taped) the front and a full seal (all four sides taped) to the wound on the backto the wound on the back
Assessing The ChestAssessing The Chest
Compare Compare both sides of both sides of the chest at the chest at the same the same time when time when assessing for assessing for asymmetry.asymmetry.
Open Chest WoundOpen Chest Wound
Open Chest WoundOpen Chest Wound
Seal and Dress Open Chest Seal and Dress Open Chest WoundWound
Open field dressing wrapperOpen field dressing wrapper
Have casualty exhaleHave casualty exhale
Place wrapper over woundPlace wrapper over wound
Tape wrapper in placeTape wrapper in place
Apply field dressingApply field dressing
Secure dressing (tie directly Secure dressing (tie directly over the wound) over the wound)
Open Chest WoundOpen Chest Wound
Position casualty on side with injured Position casualty on side with injured side next side next to groundto ground
Allow casualty to sit up if it is easierAllow casualty to sit up if it is easier
Seek medical helpSeek medical help
Monitor breathingMonitor breathing
Treat for shockTreat for shock
EvacuateEvacuate
Impaled ObjectImpaled Object
Impaled ObjectImpaled Object
► If the casualty is unconscious or cannot If the casualty is unconscious or cannot hold his breath, place the airtight hold his breath, place the airtight material over the wound after the chest material over the wound after the chest falls but before it rises.falls but before it rises.
► If the casualty is conscious and wants If the casualty is conscious and wants to sit upright, allow him to sit with his to sit upright, allow him to sit with his back against a tree or other supporting back against a tree or other supporting object.object.
Open PneumothoraxOpen Pneumothorax
Open PneumothoraxOpen Pneumothorax
Open PneumothoraxOpen Pneumothorax
Petroleum Gauze can also be used to seal a sucking chest wound.
►Air enters thoracic space but Air enters thoracic space but cannot escape, pressure builds cannot escape, pressure builds and further collapses the lung and further collapses the lung and forces mediastinum and and forces mediastinum and heart away from effected lung. heart away from effected lung. May also compromise good lung May also compromise good lung and major vessels to the heart.and major vessels to the heart.
Tension PneumothoraxTension Pneumothorax
Tension PneumothoraxTension PneumothoraxTension PneumothoraxTension Pneumothorax
►Tension pneumothoraxTension pneumothorax is the is the second leading cause of preventable second leading cause of preventable death on the battlefield.death on the battlefield.
►Consider progressive, severe Consider progressive, severe respiratory distress resulting from respiratory distress resulting from unilateral chest trauma to represent unilateral chest trauma to represent a tension pneumothorax and a tension pneumothorax and decompress.decompress.
Tension PneumothoraxTension Pneumothorax
Air pushes over heart and collapses lung
Heart compressed not able to pump well
Air outside lung from wound
Tension PneumothoraxTension Pneumothorax Anxiety, agitation, apprehensionAnxiety, agitation, apprehension
Increasing dyspnea with cyanosisIncreasing dyspnea with cyanosis
TachypneaTachypnea
Tracheal shift (late sign)Tracheal shift (late sign)
Distended neck veinsDistended neck veins
Hypotension - loss of radial pulseHypotension - loss of radial pulse
Cool clammy skin, patient deteriorates rapidlyCool clammy skin, patient deteriorates rapidly
These signs are hard to detect in a combat environmentThese signs are hard to detect in a combat environment
Needle Chest Needle Chest DecompressionDecompression
► IndicationsIndications Penetrating chest wound with Penetrating chest wound with
progressive respiratory distressprogressive respiratory distress► Required MaterialsRequired Materials
10 to 14 gauge I.V. needle w/catheter 10 to 14 gauge I.V. needle w/catheter 2.5-3 in long2.5-3 in long
Betadine or Alcohol Prep PadsBetadine or Alcohol Prep Pads 1/2” Tape1/2” Tape
Needle Chest Needle Chest DecompressionDecompression
A needle chest decompression is A needle chest decompression is performed performed ONLYONLY if the casualty has if the casualty has a penetrating wound to the chest and a penetrating wound to the chest and increased difficulty breathing.increased difficulty breathing.
Performing a Needle Performing a Needle Chest DecompressionChest Decompression
Obtain a large bore (14 ga) needle Obtain a large bore (14 ga) needle and catheter unit and strip of tape and catheter unit and strip of tape from your aid bag.from your aid bag.
Tension PneumothoraxTension Pneumothorax
►Burp the wound:Burp the wound:
If no capability of NCD exists and the If no capability of NCD exists and the patient continues to have progressive patient continues to have progressive respiratory distress, remove the occlusive respiratory distress, remove the occlusive dressing and stick a gloved finger into the dressing and stick a gloved finger into the open wound and burp the wound.open wound and burp the wound.
Needle Chest Needle Chest DecompressionDecompression
► Review anatomy of the chest and Review anatomy of the chest and
identify the following anatomical identify the following anatomical
landmarks on the side of the open landmarks on the side of the open
wound & tension pneumothoraxwound & tension pneumothorax
Mid-clavicular lineMid-clavicular line
Second intercostal spaceSecond intercostal space
superior edge of the 3rd ribsuperior edge of the 3rd rib
Needle Chest Needle Chest DecompressionDecompression
► Steps for performing the procedure:Steps for performing the procedure: Casualty may be lying flat, sitting, etc. Casualty Casualty may be lying flat, sitting, etc. Casualty
positioning isn’t dependant on any specific position positioning isn’t dependant on any specific position for this procedurefor this procedure
Site preparation may be accomplished by using Site preparation may be accomplished by using either alcohol and/or betadine prep pads to either alcohol and/or betadine prep pads to disinfect the skindisinfect the skin
Using your index finger, trace the mid-clavicular Using your index finger, trace the mid-clavicular line, then identify the second intercostal space line, then identify the second intercostal space (between the second and third rib) on the side of (between the second and third rib) on the side of the tension pneumothoraxthe tension pneumothorax
Needle Chest Needle Chest DecompressionDecompression
►Steps for performing procedure:Steps for performing procedure: Insert the needle perpendicular to the Insert the needle perpendicular to the
chest wall, directly over the top of the chest wall, directly over the top of the third rib until a palpable pop is felt, third rib until a palpable pop is felt, followed immediately by a hissing or air followed immediately by a hissing or air escaping from the chest cavityescaping from the chest cavity
A rush of air confirms the diagnosis and A rush of air confirms the diagnosis and rapidly improves the patient’s conditionrapidly improves the patient’s condition
Performing a Needle Performing a Needle Chest DecompressionChest Decompression
Firmly insert the needle into the skin at a Firmly insert the needle into the skin at a 90 degree angle.90 degree angle.
Needle Chest Needle Chest DecompressionDecompression
ComplicationsComplications
Laceration of the intercostal Laceration of the intercostal vessels or nerve may cause vessels or nerve may cause hemorrhage or nerve damagehemorrhage or nerve damage
Questions????Questions????