Chest, Abdomen,

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Chest, Abdomen, Genitalia Injuries
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Chest Anatomy

• Thoracic cavity surrounded by ribs
• Protects vital organs for breathing and
  circulation
  
• Heart
• Lungs
• Mediastinum - middle of chest cavity
• Trachea, esophagus
• Venae cavae, aorta

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Categories of Chest Injuries

• Closed injuries - blunt trauma
• Open injuries - penetrating trauma
• Cavitation
• Hollowing out of tissue along the path of a bullet

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Sucking Chest Wound

• Air pulled into the chest cavity from an open
  wound sometimes causing a sucking sound
  
• Complications
• Air sucked in
• Air trapped inside

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Emergency Care/Sucking Chest Wound

• Positive pressure ventilation
• Seal open wound with gloved hand
• Apply occlusive dressing tape 3 sides
• Position the patient

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Complications Associated with Sealed Wound

• Difficulty breathing
• Tachypnea
• Decreased or absent breath sounds
• Tachycardia
• Decreasing BP with narrowing pulse pressure
• JVD - late sign
• Tracheal deviation - late sign
• Unequal chest movement
• Extreme anxiety
• Increased resistance to positive pressure
  ventilation

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Flail Segment

• 2 or more consecutive ribs fractured in 2 or more
  places
  
• Causes movable segment to be sucked in during
  inhalation
  
• Causes segment to move outward during exhalation
• Creates paradoxical motion or opposite of normal
  function

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Emergency Care/Flail Segment

• Place gloved hand over flailed segment
• Initiate positive pressure ventilation
• Stabilize with bulky dressing, pillow, or towel
• If possible secure patients arm to body to help
  stabilize the area

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Pulmonary Contusion

• Often caused from flail segment
• Bleeding occurs between alveoli and capillaries
  reducing oxygen exchange
  
• Signs Symptoms
• Dyspnea
• Cyanosis
• Other signs of blunt trauma

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Emergency Care/Pulmonary Contusion

• Follow all normal procedures
• Positive pressure ventilation with supplemental
  oxygen is the best treatment for this condition

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Pneumothorax

• Air in the thoracic cavity
• Causes
• Blunt trauma
• Penetrating trauma
• Lung ruptures if during impact patients
  epiglottis is closed over the trachea (paper bag
  effect)

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Signs Symptoms

• Chest pain worsening with inspiration
• Dyspnea
• Tachypnea
• Decrease or absent breath sounds on affected side

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Spontaneous Pneumothorax

• Congenitally weak area in lung surface
• Common among smokers, and emphysema patients, and
  tall skinny people

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Signs Symptoms

• Sudden onset of dyspnea
• Respiratory distress
• Sharp chest pain
• Absent breath sounds on one side

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Tension Pneumothorax

• Immediate life-threatening condition
• Results from pneumothorax
• Trapped air begins to affect uninjured side
• Affects other vital organs
• Death can occur rapidly

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Signs Symptoms

• Rapid deterioration
• Severe respiratory distress
• Shock (hypoperfusion)
• Absent breath sounds
• Cyanosis
• Unequal movement of chest
• Distended neck veins
• Diminished breath sound on uninjured side
• Tracheal deviation

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Emergency Care

• If caused by occlusive dressing, lift corner to
  allow air to escape
  
• If a tension pneumothorax is suspected, rapid
  transport is critical
  
• Consider ALS but do not delay transport for ALS

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Hemothorax

• Blood filling the chest cavity
• Caused by blunt or penetrating trauma
• Signs symptoms the same for shock with the
  addition of pink or red frothy sputum when the
  patient coughs.
  
• Neck veins are flat
• Care is the same as for a pneumothorax

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Traumatic Asphyxia

• Severe and sudden compression of chest
• Pressure on heart and lungs causes backflow of
  blood out of left ventricle and into veins of
  head, shoulders, and upper chest
  
• Patient looks like they were strangled

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Signs Symptoms

• Bluish or purple discoloration of face, neck,
  head, shoulders, upper chest
  
• JVD
• Bloodshot or bulging eyes
• Cyanotic swollen tongue, lips
• Provide emergency care for wounds and treat for
  shock
  

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Cardiac Contusion

• Bruise on the heart wall
• Disturbances in the electrical conduction system
  may occur
  
• Signs symptoms
• Chest pain
• Signs of blunt trauma
• Tachycardia/irregular pulse
• Prompt transport is required

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Pericardial Tamponade

• Bleeding into the pericardium (sac around heart)
• Compression of the heart reducing cardiac output
• Common cause penetrating wound
• Signs symptoms same as for tension
  pneumothorax
  
• Requires prompt recognition and transport

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Rib Injury

• Third through eighth laterally most commonly
  fractured
  
• Can cause internal bleeding
• Signs symptoms
• Pain while breathing
• Crepitation
• Tenderness upon palpation
• Deformity of chest wall
• Shallow respirations
• Coughing, Tachypnea

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Rib Injury

• Place patients arm over injury site and apply
  sling and swathe
  
• Give patient pillow to hold for added support
• Do not completely wrap or tape the chest

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General Emergency Care/Chest Injuries

• Maintain open airway
• Oxygen therapy
• Reevaluate breathing status
• Stabilize impaled object in place
• Completely immobilize the patient
• Treat for shock
• Transport

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Abdominal Cavity

• Organs
• Digestive system
• Urinary system
• Endocrine system
• Peritoneum
• 2 layer sheath membrane lining the abdominal
  cavity

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Hollow Organs

• Stomach, gallbladder, urinary bladder, small
  intestine, large intestine
  
• Less stationary than solid organs
• Do not contain many blood vessels
• Do contain gastric juices, bacteria, urine
• Spilled contents causes inflammation irritation
  of the peritoneal lining known as peritonitis

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Solid Organs

• Liver, spleen, pancreas, kidneys
• Contain very rich blood supply
• Major complication is bleeding and hypoperfusion

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Vascular Structures

• Abdominal aorta, inferior vena cava
• If lacerated or torn, massive bleeding will lead
  to hypoperfusion and death

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Abdominal Injuries

• Causes
• Blunt trauma
• Penetrating trauma
• Degenerative processes
• Wounds
• Open
• Closed

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Assessment

• BSI
• Initial assessment
• Knees flexed toward chest
• Focused history/physical exam
• Rapid trauma Assessment
• Baseline vitals/SAMPLE
• Detailed
• Ongoing

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Inspect Palpate Abdomen

• Inspect for DCAPBTLS
• Bruising
• Palpate starting from furthest point away from
  pain
  
• Note tenderness or pulsating masses
• Guarding
• Voluntary patient contracts to guard against
  pain
  
• Involuntary by reflex

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Signs Symptoms

• DCAPBTLS
• Pain that gets progressively worse
• Rigid abdominal muscles
• Legs drawn up
• Distended abdomen
• Discoloration
• Rapid shallow breathing
• Signs of shock
• Nausea/vomiting
• Abdominal cramping
• Pain radiating to either shoulder
• Weakness

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General Emergency Care

• Maintain airway
• Big Os
• 15 lpm NR adequate breathing
• Positive pressure BVM inadequate
• Treat for shock
• Control bleeding
• Position Patient - NPO
• Stabilize impaled object
• PASG if protocol permits
• Rapid transport

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Emergency Care/Abdominal Evisceration

• Do not touch or replace
• Expose wound
• Position patient
• Apply clean, sterile, saline soaked dressing
• Cover with occlusive dressing
• Apply a second dressing
• Inflate legs only of PASG if permitted
• Administer Big Os
• Treat for shock
• Transport

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Genitalia/Male

• Male injuries include
• Lacerations, abrasions, penetrations, contusions
• Excruciating pain and cause great concern to
  patient
  
• Treatment is the same as for all soft tissue
  injuries
  

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Genitalia/Female

• Injuries include straddle, sexual assault, blunt
  trauma, abortion attempts, lacerations, and
  foreign bodies inserted into the vagina
  
• Large number of nerves produce excruciating pain
  and cause for great concern
  
• Very vascular
• Control bleeding with direct pressure using a
  sanitary napkin
  
• NEVER PACK OR PLACE ANYTHING IN THE VAGINA
• Provide Big Os
• Treat for shock
• Transport