Thoracic Injuries
The vital organs of the thoracic cavity
Heart
Lungs
Major vessels
Well protected by the rib cage
Takes high energy and velocity forces to cause injury
Anatomy
Assessment
Must be thorough, efficient, and focused on the
mechanism of injury.
Observe general appearance while determining level of
consciousness
Evaluating the ABCs (airway, breathing, circulation).
Valuable information regarding the severity of the
condition by:
Level of anxiety
Ability to speak in full sentences
Assessment
The mental status of the athlete is also important to
determine because alterations in mental status are the
first signs of hypoxia.
Any athlete with difficulty breathing and who is
unable to speak in full sentences needs emergent
referral to a hospital.
Assessment
Vital signs, including:
Blood pressure
Pulse oximetry
Pulse rate and quality
Skin color
Temperature
Quality and frequency of respirations
Assessment
Evaluating the quality of respirations; be alert for the
following:
Nasal flaring: the nostrils opening wide on inhalation
Tracheal tugging: the Adam’s apple is pulled upward on
inhalation
Retraction of the intercostal muscles on inhalation
Use of the diaphragm and neck muscles to assist inhalation
Use of abdominal muscles on exhalation
Cyanosis
Assessment
Auscultation of the lungs will determine the quality of
respirations and efficiency of air movement.
Should listen at each site during expiration and
inspiration for air movement.
Sites of auscultation
Assessment
Palpate the chest by gently placing hands on the rib cage
and feel for the rise and fall during breathing
Should be equal in motion, rate, and rhythm
Palpate the bony structures, looking for:
Deformity of the ribs
Unstable segments
Congruency of the sternoclavicular and costosternal joints
Presence of swelling, crepitus, or crackling of
subcutaneous emphysema
Assessment
Pain elicited by compressing the thorax front to back or inward
from the sides indicates the possibility of a fracture to the ribs
• Percuss the chest, indicate the density of the
underlying tissue
Normal: a resonant sound equal bilaterally
Hyperresonant: excessive air accumulating in the thorax as would
be present in the case of a pneumothorax
Dull: the presence of fluid in the lung such as in the case of a
hemothorax
Percussion
Assessment
Notice should be taken to:
Erythema
Ecchymosis
Deformity
Paradoxical movement
Alignment of the trachea
Assessment
In the case of an open wound, determine if air
movement in and out of the wound is present
Determining the presence of an exit wound would
Any injury to the thoracic cavity may lead to shock
either acutely or over time.
Observation of the skin color may be informative in
identifying the onset of shock
Assessment
Pale, ashen, or cyanotic coloring would be indicative
of respiratory collapse
Red, dark-red, or blue coloring of the head and neck
would be indicative of traumatic asphyxia
Types of Injuries
Fractures
Dislocation
Types of Injuries
Pneumothorax
Types of Injuries
The athlete will present with a sudden onset of a sharp
chest pain and difficulty breathing after exercising,
strenuous coughing, or even air travel.
Tension Pneumothorax
A pneumothorax that expands to the point where it
compresses on the aorta, heart, and superior and
inferior vena cava is called a tension pneumothorax and
is a life-threatening injury
Types of Injuries
If breathing sounds are absent on the affected side and
severe dyspnea and jugular vein distension are present,
then a tension pneumothorax should be immediately
suspected.
Affected athletes will appear anxious and restless,
hypotensive with a rapid and thready pulse, and on the
verge of circulatory collapse.
Percussion will result in hyperresonanceon the
affected side.
Types of Injuries
If the athlete is unconscious or unable to breathe
adequately, then assist respirations with a bag-valve
mask.
If the symptoms still do not improve, needle
decompression must be performed rapidly
Types of Injuries
Open Pneumothorax
The severity of this condition is dependent on the size
of the opening in the chest wall and the causative
agent such as a bullet, knife, or javelin.
Management of an open pneumothorax includes
administration of high-flow oxygen and monitoring of
vital signs, especially respiratory effort and efficiency.
Open Pneumothorax
Treatment of an open pneumothorax involves creating
a one-way valve with a dressing.
Covering the opening with a sterile occlusive dressing.
If significant improvement is not seen, endotracheal
intubation is indicated.
Hemothorax
Blood entering the pleural cavity results in a
hemothorax, and the mechanism is the same as a
pneumothorax.
If the lungs become compromised, the athlete will
develop dyspnea and chest pain and the jugular veins
will become distended
Effective treatment of a hemothorax includes oxygen
supplementation and respiratory support.
Intravenous fluid resuscitation is undertaken with
great care because an overload of fluid may result in
significant pulmonary edema and difficulty in
ventilation during the hospital course of treatment.
Rapid transport to a trauma center is essential.
Pulmonary Embolism
A blood clot that enters the venous system and lodges
in the lung results in a pulmonary embolism.
The clot blocks pulmonary circulation, and dead space
in the lung increases.
Symptoms of an acute pulmonary embolism include a
sudden onset of chest pain, dyspnea, tachycardia, and
bloody sputum.
Treatment includes early recognition, oxygen
administration, and rapid transport to the hospital
