Blunt chest injury assessment

a) Primary assessment treatments

a. Based on the mechanism of injury, consider manual stabilization of the cervical spine

until a more complete spinal exam can be accomplished. Establish and maintain a

patent airway while determining the patient's level of consciousness using the AVPU

scale. If the patient is not fully awake or alert, manual airway positioning and basic

airway adjuncts such as an OPA or NPA may be needed. Suctioning an airway filled

with blood or emesis may be necessary.

b) Seal chest wounds

a. Any open chest wound should be sealed as soon as it is found, using the palm of a

gloved hand at first, followed by an occlusive dressing.

c) Relieve tension pneumothorax

a. Tachypnea, hypopnea (shallow breathing) and accessory muscle use are key

indicators of respiratory distress orfailure. Expose the chest and auscultate lung

fields immediately. Diminished sounds over one side may indicate a loss of lung

capacity, either from a hemothorax, pneumothorax or both.

b. Inspect the neck and chest area. Jugular venous distension may indicate greater than

normal pressure within the chest cavity, possibly related to a developing tension

pneumothorax. Hyperinflation of the chest over one side is another sign related to a

tension pneumothorax. If the patient's mental status worsens and blood pressure

falls, a decompression of the tension pneumothorax using a long, large gauge

angiocatheter is needed to relieve the excessive pressure in the chest.

d) Control hemorrhage

a. Control any major external bleeding immediately with direct pressure. It will be

difficult to create a pressure dressing, as is more commonly seen with extremity

injuries. Manual pressure may be needed to stop the bleeding. Recognize that the

chance of active bleeding inside the chest is significant and emergent transport to a

trauma center is needed.

e) Package fortransport

a. Unless there are clear signs of neurological deficit, avoid placing the patient with

penetrating chest trauma in spinal precautions. Being supine may worsen respiratory

distress and delay transport.

b. In general, on-scene management of chest trauma should be done with BLS

interventions, with the intent to begin transport to a trauma center as soon as

feasible. With the exception of the needle decompression, other advanced level

procedures are best done while en route.