The ribs protect the lungs.  Chest injuries can be life threatening by causing breathing difficulties.  These injuries may not be obvious and a thorough examination is needed.  The casualty’s condition can deteriorate rapidly, so the need for constant assessment is required

 

Fractured Ribs:

Fractures of the ribs can be caused by direct force to the chest area.  The fracture may be a closed fracture, but the ribs can also be pushed into the lung, damaging the lung, causing bleeding to occur into the lungs or chest cavity.

 

Flail Segment:

This occurs when several ribs are fractured in two or more places, causing part of the ribcage to become loose.  The fractured ribs involved move in the opposite direction to the rest of the ribcage during respiration.  This is called Paradoxical Breathing.  This injury is common in motor vehicle accidents, especially with elderly casualties.  This type of chest injury can be serious as it can cause damage to the lungs

 

Penetrating Chest Wound:

This could be caused by an accident where fractured ribs damage the soft tissues, as a result of a stabbing, gunshot, or impaled object. This injury may cause the lung to collapse and create breathing difficulties.  Treatment must commence immediately.  The medical name for this condition is Pneumothorax.  Bleeding into the lung may also occur, further complicating the casualty’s injury.

 

Causes

• Accidents – steering wheel blow, seatbelt crushing on the chest, exploding airbags
• Heavy falls or falls from a great height

Note: Always be suspicious of falls greater than five metres or a high-speed car accident over 60km/h

• Crushing
• Stabbing
• Gunshot

 

Signs and Symptoms may include:

• Breathing may be short, rapid and gasping
• Chest pain increases when deep breathing or coughing
• Favours injured side
• Possible hole in the chest
• Possible rapid pulse
• Sucking noise can be heard when inhaling Decreased chest movement
• Skin may be pale or blue
• Obvious chest injury – bruising, indent, red area
• Anxiety
• Restlessness
• Bloodstained frothy sputum
• Embedded object  

 

 

 

Treatment

Follow the Basic First Aid Plan to assess the casualty

ü Assist casualty into a half sitting position, with the injured side leaning down

ü If casualty is unconscious, place casualty onto their side with the injured side down. Seek urgent medical aid

ü Support the area by placing bulky padding (towel or jumper) over the injured site and securing in place with 2 broad bandages above and below the injured site, and tie off on the uninjured side

ü For penetrating chest wound place a dressing or gloved hand on the wound until an airtight dressing is obtained e.g. plastic bag, alfoil, or sterile non-adhesive dressing. Tape the top and both sides of the airtight dressing. Do not tape the lower edge of the airtight dressing.

ü If an object is embedded in the chest:

Never remove the embedded object

ü Apply padding or dressings around the embedded object to support the embedded object and to help control bleeding

Do not apply direct pressure over the object

ü Immobilise the arm with a cuff and collar sling

ü Seek medical aid

ü Watch for signs of shock

ü Seek medical aid