Chapter19Lecture
Chapter
Book Title
Edition
Injuries to the
Chest and
Abdomen
Slide Presentation prepared by
Randall Benner, [Link]., NREMT-P
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Chest Injuries
• Types
– Blunt trauma (caused by a blow)
– Penetrating injury (an object penetrates)
– Compression injury (chest cavity is rapidly
compressed, as in a car accident)
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Blunt trauma (caused by a blow)
– the skin is not injured,
– can cause serious underlying damage especially
lacerations to or rupture of the heart, lungs, and large
vessels.
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open (penetrating) chest injuries
• the skin is broken,
• Severe internal damage along the path of
penetration.
Chest Injuries: Signs and Symptoms
• Pale, cool, clammy skin
• Cyanosis (bluish coloring of lips, fingers or skin)
• Dyspnea (shortness of breath or trouble
breathing)
• Rapid breathing
• Tracheal deviation
(displacement to one side)
• Painful breathing
• Distended neck veins
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Chest Injuries: Signs and Symptoms
• Pain at injury site
• Coughing up blood
• Failure of the chest to
expand normally
• Rapid, weak pulse
• Open wound on the chest
• Bruising or deformity of the chest wall
• Altered mental status, such as confusion,
agitation, restlessness, irrationality
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First Aid Care for Chest Injuries
• First priority is to open and maintain the airway;
provide rescue breathing if needed.
• Place an occlusive (watertight and airtight)
dressing.
• Never try to remove impaled objects; instead,
stabilize them and call EMS.
• If there is an impaled object
– Expose the wound (remove or move clothing,etc.)
– Dress wound around the object (control bleeding).
– Stabilize the impaled object with bulky bandages or
dressings.
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Flail Chest
• Often results when two or more adjacent ribs are
fractured in two or more places
• Occurs when the chest wall becomes unstable
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Flail Chest
• The segment of chest wall becomes free floating
impairment of chest integrity
• paradoxical movement
- When the victim inhales, the area does not
expand but moves inward;
- when the victim exhales, the flail section moves
outward.
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Flail Chest
• Should suspect possible lung tissue injury
• Considered a life-threatening injury:
- inadequate breathing
- bruise the lung tissues,
lead to inadequate oxygenation
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Signs and symptoms of flail chest include:
• Difficulty in breathing
• Increased breathing rate
• Shallow breathing
• Severe rib pain
• Paradoxical chest wall movement
• Bruising to the injured area
• Rapid heart rate
• Victim’s attempt to support the chest wall with
arms and hands
• Pale, cool, clammy skin
• Cyanosis
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flail chest First Aid Care:
• inspect the chest for paradoxical movement, and
palpate for an unstable area on the chest.
• Immediately activate the EMS system
• Maintain an open airway, and administer
artificial ventilation
• Use gentle palpation to locate the edges of the
flail section; stabilize with a pad of dressings or a
pillow
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flail chest First Aid Care:
• a semi-sitting position or lying in a supine
position with the segment splinted with the arm;
• monitor vital signs,
• care for shock.
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Compression Injury
• A life-threatening emergency
• Causes rapid increase in the pressure inside the
chest
• severe pressure on the heart, causing it to be
bruised.
• Traumatic asphyxia occurs, causing blood to
stop flowing or flow backwards
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Compression Injury: Signs and Symptoms
• Pale, cool, clammy skin
• Weak, rapid pulse
• Difficulty breathing
• Distended neck veins
• Bloodshot, protruding eyes
• Bluish tongue and lips
• Swollen appearance of head, neck, shoulders
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Compression Injury: first aid care
• Activate the EMS system immediately
• Maintain an open airway, and administer
artificial ventilation
• Control any bleeding
• Monitor the victim’s airway, ventilation,
and vital signs closely;
• position the victim in a supine position with
the head, neck, and spine in a neutral
inline position.
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Broken Ribs
• can cause injuries that are (organ puncture or
laceration)
• Most common symptom is severe pain
• Other symptoms include
– Grating sound with palpation
– Shallow, rapid breathing
– Frothy blood from nose or mouth
– Bruising or evidence of trauma
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Hemothorax and Pneumothorax
• Hemothorax: Accumulation of blood in the
pleural space (fluid around lungs)
• Pneumothorax: Accumulation of air in the
pleural space
• Both conditions cause lungs to collapse
• Three types of pneumothorax, all life-threatening
– Pneumothorax
– Open pneumothorax
– Tension pneumothorax
• Activate EMS immediately.
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Pneumothorax
Chest Injury Complications
The more air that is allowed to accumulate in the pleural
space, the greater the collapse of the lung will be.
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Abdominal Injuries
• Should suspect possibility of chest trauma
• The abdominal cavity has solid organs, hollow
organs, and large vessels.
• Injury to a large vessel leads to severe
hemorrhage and blood loss.
• Solid organs can bleed profusely
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Abdominal Injuries
• Hollow organs can spill contents contain very
strong irritating chemicals and bacterial.
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Abdominal Injury: Signs and Symptoms
• Bruising
• Tenderness (pain on
palpation)
• Local pain (from mild to
intense)
• Pain other than at injury site,
or radiating to shoulder(s)
• Victim guards the area
• Victim assumes a fetal
position
• Weak peripheral pulses
• Cramping
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Abdominal Injury: Signs and Symptoms
• Abdomen is rigid or hard
on palpation
• Nausea or vomiting
• Rapid, shallow breathing
• Rapid pulse
• Blood in urine
• Low blood pressure
• Distended or irregularly
shaped abdomen
• Organs protruding
through an open wound
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First Aid Care for Abdominal Injuries
- assess a victim for abdominal injuries
• Inspect for lacerations, open wounds,
bruising, impaled objects, or protruding
abdominal organs.
• Gently palpate all four quadrants for
guarding, rigidity, pain, and tenderness.
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First Aid Care for Abdominal Injuries
• Prevent shock; keep victim warm (not hot).
• Control bleeding, dress all wounds.
• If object protrudes, uncover it, dress nearby
wounds, stabilize it, and apply bulky dressings.
• Position the victim for greatest comfort.
• Watch for vomiting.
• Monitor vital signs constantly.
• Give the victim nothing by mouth.
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Abdominal Evisceration
• Evisceration: the protrusion of abdominal
contents (often intestines) from an open wound
• Activate EMS immediately.
• Cover organs with a sterile, moist dressing (must
not cling or disintegrate).
• Cover with occlusive (waterproof) material.
• Prevent shock, monitor vital signs.
• Never touch abdominal organs or try to replace
them in the cavity.
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Rupture or Hernia
• Hernia: occurs when part of an organ protrudes
through abdomen wall
• Most hernias occur in or just above the groin
• Result from abdominal wall weakness and/or
muscle strain
• Symptoms: sharp pain, swelling, possible
nausea and vomiting
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