By Phillip Julian - KG4NVN
(A continuing series of emergency First Aid information)
This article discusses trauma to the chest and it begins with what we in
Blunt injuries : Injuries that impact the chest
Crush injuries: Objects that fall on the chest and compress the contents within the chest.
Penetrating injuries: Objects that enter the chest cavity causing lung, vessel, or heart damage. These may either be impaled, exhibit entry wounds only, or exhibit entry and exit type wounds.
Inhalation burns: Smoke or noxious substances that damage the chest membranes including the lungs, large or small airways, or vessels of the lungs and heart.
Aspiration (inhaling) of foreign bodies: Objects, water, caustic materials or any trash that can either block the airway or damage the lung tissues.
2 major forces within chest which lead to injury: compression and distraction. Compression results in destruction of vascular components (blood vessels being squeezed) , hemorrhage (blood loss due to vessel rupture), edema (accumulation of either blood or fluid) and impairment of function. Distraction injuries usually result in shearing forces which destroy integrity of chest organs within the chest such as the aorta (a major blood vessel responsible for carrying oxygen rich blood to the body) in addition to potential damage to the diaphragm and other vital oxygen carrying structures.
BLUNT FORCE TRAUMA: Motor vehicle accidents are the most common we may come across on a daily basis since we, as Amateur Radio Operators, are very mobile in and around our communities. Falls are another type we may additionally encounter.
Type of injury is important
- Where there has been massive deformity of a car or a history of a fall of 15 feet or more major intrathoracic (within the chest) injuries should always be suspected. The physical nature of chest wall allows for considerable elastic recoil, especially in young victims and therefore degree of injury within chest may need to be judged initially by deformity to car rather than appearance of patient
- Blunt injuries occur in 3 major directions: AP (Anterior-Posterior [front to back]) , lateral and transdiaphragmatic (across the diaphragm which is the major muscle of respiration).
- AP deformity results in relative backward motion of heart. This may result in disruption of aorta at level of ligamentum arteriosum just below left subclavian. As heart swings back and up it may cause so-called wishbone (pulling apart)of a proximal bronchus (major airway structure)
- Injuries to heart occur in up to 50% of patients after deceleration injuries
- Deceleration with impact to back causes relatively few intrathoracic injuries
- Lateral compression of chest during deceleration causes fractures typically of lower ribs with risk of injury to liver, spleen and kidneys which can cause major bleeding leading to severe shock and potentially death.
- When lateral compression results in flail (freely floating) rib segments, damage to thoracic cavity is usually relatively small and most frequently limited to contusion (bruise) and laceration (cutting) of lung parenchyma
- Lap belt of seat belts leads to rise in intrabdominal (great pressure within the belly) pressure in massive deceleration and this, combined with shearing and twisting of upper trunk may result in diaphragmatic rupture.
Penetrating Injuries
Result in tissue damage related to track of missile or stabbing implement and velocity. More solid structures such as the heart and major blood vessels suffer greater injury. High-velocity missiles and penetrating weapons yield the most lethal complication, hemorrhage. These are often associated with abdominal trauma.
Crush injury
1. Occurs where elastic limits of chest and its contents have been exceeded
patients usually have AP deformity.
2. Majority have flail chests with multiple fractures, pneumothorax (air within the chest cavity that is outside the lungs) or hemothorax (blood collection within the chest that is outside the normal vessels).
3. Most have pulmonary contusion (bruised lungs).
4. Injuries of heart, aorta, diaphragm, liver , kidney and spleen are common.
5. Another group of patients with crush injuries are those with "traumatic asphyxia" syndrome, where constrictive forces are applied over a wide area for as little as 2-5 minutes. Profound venous hypertension (increased pressure) associated with relative stasis (lack of blood flow) is mechanism of injury. There is widespread capillary dilation and rupture, subconjunctival hemorrhage and retinal hemorrhage (blood vessel rupture within and around the eye). Simultaneous injuries (eg intracranial hemorrhage[bleeding within the brain]) must be suspected. This may lead to altered levels of consciousness.
6. Severe crush injuries have a high mortality.
These are just a few items to ponder if you come across anyone suffering from these types of injuries. Remember the ABC’s and keep in mind that even though a victim may not be exhibiting the signs and symptoms of shock, they may quickly progress to a shock state at anytime. Plan to treat accordingly. These injuries can be catastrophic if not managed quickly and appropriately. Next we will look at some things you can do to ensure care is provided in the quickest manner to help prevent death.
