Emergency Management of Chest Injury - A Comprehensive Review

Introduction:

Chest injuries is one of the leading causes of death due to trauma (nearly one-fourth of all injuries). Injuries to the chest can occur due to penetrating or blunt trauma. Gunshots, punctures, stabs, and lacerations can lead to penetrating wounds in the chest. Motor vehicle accidents, blasts, accidental falls, burns, or crush injuries can lead to severe blunt chest injuries. These life-threatening injuries require prompt medical intervention and treatment. Rapid transport to the hospital is critical, considering the potentially life-threatening complications that can occur due to injury to the chest. The emergency medical services personnel initiate life-saving measures and quickly transfer the patient to the hospital to initiate invasive life-saving procedures and surgeries.

What to Do if Someone Has a Severe Chest Injury?

Chest injuries can be life-threatening (blunt or penetrating injury). However, one can initiate simple care to stabilize the patient until the emergency medical personnel arrives. The following steps can help to manage acute chest injury scenarios:

1. Seek Medical Help Immediately:

• Call emergency medical services immediately for any serious injury to the chest.

• One must be aware that even if there are no obvious external wounds, there may be severe injury internally (especially in blunt trauma).

2. Begin Cardiopulmonary Resuscitation (If Necessary):

• After the chest injury, if the patient has stopped breathing, is unresponsive, or is gasping for air, one must initiate cardiopulmonary resuscitation. This ensures heart function and oxygen-rich blood flow throughout the body.

• Chest compressions, rescue breathing, and shock delivery (defibrillation) using an automated external defibrillator (AED) can help the patient survive.

3. Cover Open Wounds:

• If the patient has sustained open wounds, use a sterile cloth or pad (depending on what is at hand) and cover the wound.

• Try to cover two inches beyond the edge of the chest wound.

• Suppose one can hear air passing through the chest cavity or see blood bubbling up from the wound; tape the cover down on three sides. This prevents air from building up in the chest.

• Do not attempt to remove objects that penetrate the chest (in case of penetrating trauma).

4. Control Bleeding (If Necessary):

• If there is bleeding from the wound, apply pressure over the dressing to control bleeding.

• If the bleeding is severe and blood soaks through the initial dressing, apply additional dressing on top of the previous one (without removing the old dressing).

5. Patient Positioning:

• One can place the injured person in a position (on the injured side or sitting up) to help them breathe easier.

6. Monitor Continuously:

• Monitor the patient for breathing, oxygen deprivation signs, and responsiveness.

• If the patient’s breathing becomes weak, initiate cardiopulmonary resuscitation.

How Are Chest Injury Emergencies Managed?

When caring for a chest injury patient, the emergency medical personnel have the following crucial tasks:

1. Initiation of life-saving basic and advanced life support measures (for resolution of the airway, breathing, and circulation issues).

2. Prompt physical examination of the injured.

3. Quick recognition and stabilization of the chest injury and other injuries.

4. Efficient and timely transportation of the injured to the nearby hospital or trauma center.

The emergency medical team assesses the injury and stabilizes the patient. In addition, the following are initiated whenever necessary:

Airway assessment and stabilization are always the priority in chest injury patient management. The essential interventions include the following:

• Jaw thrust maneuvers.

• Supplemental oxygen delivery.

1. Bag-mask ventilation pumps oxygen through a bag attached to the mask.

2. Nasal prongs or venturi masks are specially used for patients who require close monitoring.

3. Noninvasive positive pressure ventilation is used in which mild air is blown through tubes or masks into the airway to keep it open.

• Endotracheal intubation (tubes are inserted into the airway to assist breathing and deliver oxygen).

• Assessment of the circulation is important as severe blood loss and injury to the heart is seen in chest injuries. Therefore, cardiopulmonary resuscitation and defibrillation (shock delivery to restore heart rhythm) are initiated whenever necessary.

• The patient is examined for signs of internal or external bleeding. Then, measures to control and stop bleeding are initiated. Direct pressure or a tourniquet is critical for initial bleeding management.

• Intravenous access (into veins) is obtained to administer fluid and medications for resuscitation.

• Immobilization of the spine.

• Stabilization or splinting of fractures.

• Emergency medications are administered based on the needs of the patient. In addition, pain medications are also administered to reduce pain.

• Monitoring of the heart.

• Needle decompression procedures to help stabilize chest injury patients.

• If air surrounds the lungs, it could cause the lungs to collapse. A temporary chest tube (thoracostomy) may be placed in such scenarios to remove air surrounding the lung. Chest tubes are also inserted to drain blood.

• In the case of open chest wounds, an occlusive dressing is used to help the patient breathe (for efficient lung function) during transport or until definitive treatment can be initiated.

• Multiple rib fractures can lead to a condition known as a flail chest, in which a portion of the rib cage detaches from the chest wall. These need immediate stabilization during transfer.

• A blood transfusion may be necessary if there is significant blood loss due to the chest injury.

• Treatment of specific injuries and complications of chest injuries (such as injury to the lung, heart, and fractures) are initiated based on the patient’s condition and the type of injury.

• Surgery may be necessary for a severe chest injury. A specialist (thoracic surgeon) must be involved in managing such patients. The surgery indications include the following:

1. Blood loss greater than 1500 milliliters.

2. Significant impairment of mechanical ventilation.

3. Air leakage due to the windpipe and its branches being severely damaged.

4. Injury to the heart and major blood vessels.

Conclusion:

Injury to the chest can lead to several complications affecting the heart, lungs, and other internal organs, bleeding, and fractures. These can be life-threatening. Caring for a patient with a chest injury is complex. Call emergency medical services immediately if someone has a severe chest injury (due to blunt or penetrating trauma). Chest injuries are initially managed by stabilizing the patient’s airway, breathing, and circulation. In addition, care is taken to manage wounds, bleeding, fractures, and other complications. Definitive treatment and interventions to manage specific injuries are done at the hospital. The quicker the advanced life support and treatment are initiated, the better the chance of survival and recovery.