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First Aid in Chest Injuries
1) Chest injuries can involve external trauma, damage to internal organs like the heart and lungs, and possible spinal injury. They account for 25% of trauma-related deaths. 2) The assessment and treatment of chest injuries follows the ABCDE approach - Airway, Breathing, Circulation, Disability, Exposure. This includes treating life-threatening conditions like tension pneumothorax immediately. 3) Specific injuries like rib fractures, pneumothorax, and open chest wounds require stabilization, positioning the patient for comfort, applying dressings, and providing supplemental oxygen while seeking urgent medical care.
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First Aid in Chest Injuries
- 1. Chest Injuries First Aidand Treatment Options Anas Bahnassi PhD 5
- 2. Anas Bahnassi PhDCDM CDE 2
- 3. • External traumato the chest: – Blunt – Penetrating • Possible damage to underlying organs: – Heart – Lungs • Possible spinal injury. • Chest injuries are responsible for 25% of trauma related deaths. Introduction
- 4. Tri-modal peak ofMortality 1st peak: Non- survivable severe CNS or CVS injuries Location of death: Pre- hospital environment 2nd peak: First few hours after injury, most often due to hypoxia and hypovolemic shock Usually can be saved 3rd peak: Within 6 weeks of injury Cause: Multisystem failure and sepsis
- 5. The Golden Hour •Treat the greatest threat to life first • Treat despite lack of a definitive diagnosis • Treat despite complete history
- 6. The Golden Hour •A = Airway with c-spine protection • B = Breathing • C = Circulation, stop the bleeding • D = Disability/Neurological status • E = Exposure and Environment
- 7. Three Stage Approach 1.Primary Survey: ABCDE – sequential yet actually simultaneous – includes resuscitation efforts – normalization of vital signs 2. Secondary Survey: – AMPLE history – head-to-toe and x-rays 3. Definitive Care: Specialist treatment of identified injuries
- 8. Primary Assessment ABCDE Injury Resuscitation Re-evaluation SecondarySurvey Head-to-toe + X-Ray Re-evaluation Transfer Definitive Care
- 9. Initial Assessment Starting withthe ABCDE A.Airway B.Breathing C.Circulation D.Disability E.Exposure and Environment
- 10. Airway: Preventable Deaths •Failure to recognize need • Inability to establish • Incorrectly placed airway • Displacement • Failure to ventilate • Aspiration
- 11. Airway: Problem Recognition •Objective Signs – Airway Obstruction: – agitation, cyanosis = hypoxia – obtundation = hypercarbia – abnormal sounds – tracheal location – external trauma
- 12. Airway: Problem Recognition •Altered Levels of Consciousness – closed head injury – intoxication • Maxillofacial Trauma – hemorrhage – dislodged teeth – mandible fracture
- 13. Airway: Problem Recognition •Penetrating Neck Trauma – laceration of trachea – hemorrhage with tracheal deviation/ obstruction – patient may initially maintain airway – prophylactic intubation?
- 14. Airway: Problem Recognition •Blunt Neck Trauma – hemorrhage with tracheal deviation/ obstruction – disruption of the larynx • hoarseness • subcutaneous emphysema • palpable fracture – prophylactic intubation?
- 15. Airway: Management Always AssumeThis…. So Do This…. C-Spine Stabilization
- 16. Airway: Management • AirwayMaintenance Techniques: • chin lift • jaw thrust • oral airway • nasal trumpet • Definitive Airway: • orotracheal or nasotracheal intubation • surgical airway
- 17. Airway: Cricothyroidotomy Vertical skinincision – make it longer than you think you need….
- 18. Circulation: Preventable Deaths •Address: – Immediately Life-Threatening Chest Injuries: • Tension Pneumothorax • Open Pneumothorax (sucking chest wound) • Flail Chest • Disruption of Tracheo-Brochial tree – Potentially Life-Threatening Chest Injuries: • Pulmonary contusion • Diaphragmatic rupture • esophageal rupture
- 19. Check: 1. Vital signs 2.ECG 3. Pulse oximetry 4. End-Tidal Carbon Dioxide 5. Arterial Blood Gas 6. Urinary output 7. Urethral Catheterization 8. Nasogastric tube 9. Chest X-Ray 10.Pelvic X-Ray
- 20. Breathing: Problem Recognition Look Listen Feel Assess: Look •Respiratory rate • Shallow, gasping or labored breathing: Respiratory failure? • Cyanosis: Hypoxia • Paradoxical Respiration: ‘Pendulum’ breathing with asynchronisation of chest and abdomen: Respiratory failure or Structural damage. • Unequal chest inflation: Pneumothorax or Flail chest • Bruising or contusion: ‘Seat-Belt’ sign. • Penetrating chest injury • Distended neck veins: venous return-Tension pneumothorax or cardiac tamponade
- 21. Breathing: Problem Recognition Look Listen Feel Assess: LISTEN •Absent breath sounds: Apnoea or tension pneumothorax • Noisy breathing/ Crepitations/ Stridor/ Wheeze: Partially obstructed airway • Reduced air entry: Pneumothorax, Haemothorax, Heamo-pnemothorax, flail chest
- 22. Breathing: Problem Recognition Look Listen Feel Assess: FEEL •Tracheal deviation: Mediastinal shift • Tenderness: Chest wall contusion and/ rib fracture • Crepitus / Instabilty: Underlying rib fracture • Surgical emphysema: ‘Bubble-wrap’ sign
- 23. Breathing: Management The patient’shemodynamic status dictates imaging and management. • Chest tube, chest tube, chest tube • Occlusive dressing • Ventilatory support • Thoracotomy?
- 24. Indications for thoracotomy 1.Internal cardiac massage 2. Control of haemorrhage from injury to the heart 3. Control of haemorrhage from injury to the lungs/intrapleural haemorrhage 4. Cardiac tamponade 5. Ruptured oesophagus 6. Aortic transection 7. Control of massive air leak 8. Traumatic diaphragmatic tear
- 25. Circulation: Preventable Deaths •Hypotension = Hemorrhage • Assess: – level of consciousness – pulse / skin color • Address: – external bleeding – massive hemothorax – cardiac tamponade – massive hemoperitoneum – unstable pelvic fracture
- 26.
- 27. Circulation: Classes ofShock Example: • 1 year old falls off the stairway (10 kg) • “lost ¾ cup of blood” • blood volume = 70cc/kg x 10kg • EBL = ¾ cup=6 oz=180cc • 180cc / 700cc = 25%blood loss • Class II/III shock
- 28. Circulation: Causes ofShock Hypovolemic = Hemorrhage: 5 spaces = chest, abdomen, pelvis, long-bones, street • Fractures: – rib = 100-200 cc – tibia = 300-500 cc – femur = 800-1200 cc – pelvis = 1500 and up
- 29. Circulation: Causes ofShock • Neurogenic: spinal cord injury • Septic • Cardiogenic: • tension Pnemothorax • cardiac tamponade or contusion • air embolism • primary cardiac disease
- 30. 30 Fractured Ribs: ProblemRecognition • Pain at site which increases with movement or touch • Pain at site when breathing in • Difficulty breathing, Rapid shallow breathing • Rapid pulse • Bruising • Deformity • Bloody sputum • ‘Guarding’ of the injury
- 31. Fractured Ribs: Management •Primary survey - ABCDE • Position of comfort (often sitting position with the injured side downwards). • Stabilize the fracture site - Put the arm on the injured side in a ‘collar and cuff’ or a sling. • Seek medical aid • Provide supplemental oxygen if available • Observe for respiratory compromise 31
- 32. Fractured Ribs: Management •Reduction of pain with 2 week follow up • Analgesics : – Opiods – NSAID’s • Intercostal Blocks • Strapping of chest: relieves pain by immobilizing the ribs • Breathing exercises
- 33. Pneumothorax (collapsed lung) •Air enters the between the lungs and the inside of the chest wall (pleural space). • The air takes up space, causing a section of the lung to collapse. • If air continues to enter - tension pneumothorax. 33
- 34. 34 Pneumothorax: Problem Recognition •Severe chest pain • Breathing distress (Rapid, shallow breathing) • Rapid pulse • Bluish skin color (cyanosis) • Possible altered conscious state • Possible deviated windpipe (trachea) • Distended neck veins
- 35. 35 Pneumothorax: Management • Seekimmediate medical aid, • Primary Survey • Oxygen provision • Resuscitation if required
- 36. 36 Flail Segment • Whenribs and/or the breastbone are fractured in a number of places and result in a free-floating section of bone.
- 37. 37 Flail Segment: ProblemRecognition • As for fractured rib but more severe • Paradoxical breathing • Mediastinal Flutter • Pendular Movement of air • Associated injuries: Pulmonary Contusion! • Hypoventilation
- 38. Flail Segment: Management •Primary Survey • Urgent medical assistance • Position of comfort. (This is often a sitting position with the injured side downwards). • Stabilize the fracture site as for a fractured rib • Provide supplemental oxygen 38
- 39. Open Chest Wound: ProblemRecognition • Open wound to chest • Severe breathing difficulty • Rapid pulse • Sound of air being sucked in through wound 39
- 40. Open Chest Wound:Management • Urgent medical assistance • Position the victim in a sitting position with the injured side downwards • Cover the wound site with some air tight material (e.g. polythene). • This dressing needs to be taped on three sides with the bottom edge left free. This will stop air being sucked in but will allow trapped air to escape • Provide supplemental oxygen if able • Continuously monitor and reassure the victim • If the victim becomes unconscious, conduct a Primary Survey and take appropriate action 40
- 41. Clinical Pharmacy VI: FirstAid abahnassi@gmail.com http://www.twitter.com/abpharm http://www.facebook.com/pharmaprof http://www.linkedin.com/in/abahnassi Anas Bahnassi PhD CDM CDE