First aid
in case of suspected thoracic trauma
Marek Kovář
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Learning objectives
̶ Student learns the division of chest trauma
̶ Student will learn first aid management for chest injuries
̶ Student will learn to recognize the symptoms of respiratory
distress
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Chest injuries
̶ Trauma is the most common cause of death in patients
under 40 years of age
̶ According to the mechanism of injury, their division is:
1. Blunt
2. Penetrating
̶ Vital organs are stored and protected in the chest, so chest
injury has serious, often fatal consequences.
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Chest injuries
̶ can be life-threatening for the possibility of injury:
Respiratory
system
Chest
injury
Pneumothorax
Lung
contusion
Bleeding
from lung
tissue
Respiratory
tract injuries
Airway
obstruction
Hemothorax
Circulatory
system
Cardiac
tamponade
Heart
valves
damage
Myocardial
contusion
Vascular
injuries
Hemothorax
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Blunt injuries
̶ Objects exert force on a larger area, causing bruising, abrasions,
hemorrhages and lacerations
̶ They do not have to leave obvious marks on the skin, or they may
appear later
̶ Life-threatening for the frequent possibility of injury to internal organs
̶ Typical mechanisms: falls, impacts, runs over, crushing…
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Penetrating injuries
̶ Objects penetrate or damage the skin
̶ More obvious than blunt injuries, their severity depends on the
injured organs and the size of the bleeding
̶ If the foreign body is still in the wound, do not take it out in
prehospital care, for a risk of developing unstoppable bleeding
̶ Typical injury mechanisms: stabbing, cutting, shooting,…
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Examination for chest trauma
̶ Primary examination
̶ We follow the SSS ABC protocol
̶ Secondary examination
̶ Comprehensive examination of the chest and organs stored in it
̶ Many injuries of the chest and thoracic organs are difficult to
diagnose in PP conditions, watch for signs of developing shock
and respiratory distress, or breathing disorders
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Respiratory distress
- Very unpleasant shortness of breath,
choking, crouching, feeling of lack of air
- Often accompanied by a typical breathing pattern
- shallow, extremely fast, strenuous breathing with small volumes
- Requiring effort, work, often no other activity can be performed,
exhalation often needs to be forced
- One-word communication, if phonation is possible at all
- Auxiliary respiratory muscles, automatically selected sitting position,
or forward bend are often involved in breathing.
- You can hear wheezing when inhaling or exhaling - stridor
https://www.leichter-atmen.de/assets/
images/6/atemnot-5131ac36.jpg
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Pneumothorax
̶ Air penetration into the pleural cavity
ie into the space between the lungs and the chest wall
̶ Leads to lung collapse on the affected side, causes dyspnoea it is important to
monitor the symmetry of breathing movements and listening to breathing
̶ Open – connection between the atmosphere and the pneumothorax enabling air exchange
̶ Closed – communication between the atmosphere and pneumothorax is closed
most often caused by injury to the lungs or airways by the skeleton or by trauma itself
̶ Tension – a life-threatening condition in which with each breath the air in the pleural cavity
accumulates and oppresses the surrounding organs
!Do not close the wound of an open pneumothorax,
there is a risk of causing a tension pneumothorax
https://media.cdn.lexipol.com/article-images/
Blausen_0742_Pneumothorax.png
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Take-home message
̶ Chest trauma is often a life-threatening injury
̶ Especially in blunt trauma, the disability may not be obvious at
first, it is necessary to respond to the manifestations of the shock.
̶ Many interventions can only be performed by a professional or can
be solved at hospital, don’t delay by calling 911/112
̶ Apply the SSS ABC approach and monitor vital signs
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Learning outcomes
̶ Student can recognize signs of respiratory distress.
̶ Student will divide the basic types of chest injuries.
̶ Student can name life-threatening conditions associated with
chest injuries.
Zápatí prezentace12
References
̶ AUSTIN, Margaret, Rudy CRAWFORD a Vivien J. ARMSTRONG. První pomoc:
autorizovaná příručka organizací St John Ambulance, St Andrew's First Aid a British Red
Cross. V Praze: Slovart, 2015. ISBN 978-80-7391-386-1.
̶ MONSIEURS, Koenraad G., Jerry P. NOLAN, Leo L. BOSSAERT, et al. European
Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation [online]. 2015, 95, 1-
80 [cit. 2020-08-19]. DOI: 10.1016/j.resuscitation.2015.07.038. ISSN 03009572. Dostupné z:
https://linkinghub.elsevier.com/retrieve/pii/S0300957215003500
Simulation Centre, Faculty of Medicine, Masaryk University
2020