11

Ch. 9-Injuries to the Chest,Ch. 9-Injuries to the Chest,Abdomen, and GenitaliaAbdomen, and Genitalia

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9.1 Chest Injuries9.1 Chest Injuries

Blunt trauma (caused by a forceful Blunt trauma (caused by a forceful blow to the chest)blow to the chest)

Penetrating injury (an object Penetrating injury (an object penetrates the chest wall)penetrates the chest wall)

Compression injury (the chest cavity is Compression injury (the chest cavity is compressed rapidly, usually during an compressed rapidly, usually during an automobile accident)automobile accident)

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General Signs and Symptoms of General Signs and Symptoms of Chest InjuryChest Injury

Pale, cool, clammy skinPale, cool, clammy skin Cyanosis (bluish coloring of the fingernails, fingertips, lips, or skin)Cyanosis (bluish coloring of the fingernails, fingertips, lips, or skin) Dyspnea (shortness of breath or difficulty breathing)Dyspnea (shortness of breath or difficulty breathing) Rapid breathing (more than 20 breaths per minute)Rapid breathing (more than 20 breaths per minute) Tracheal deviationTracheal deviation Pain during breathingPain during breathing Distended neck veinsDistended neck veins Pain at the injury site, or pain near an injury thatPain at the injury site, or pain near an injury that

is made worse by breathingis made worse by breathing Coughing up of blood (hemoptysis), usuallyCoughing up of blood (hemoptysis), usually

bright red and frothybright red and frothy Failure of the chest to expand normally during inhalationFailure of the chest to expand normally during inhalation ShockShock Rapid, weak pulse (more than 100 beats per minute)Rapid, weak pulse (more than 100 beats per minute) Open wounds to the chestOpen wounds to the chest Bruising or deformity to chest wallBruising or deformity to chest wall Changing mental status, including confusion, agitation, restlessness Changing mental status, including confusion, agitation, restlessness

or irrational behavioror irrational behavior

44

VocabularyVocabulary

DyspneaDyspnea- Shortness of breath or difficulty in - Shortness of breath or difficulty in breathingbreathing

Tracheal deviation-Tracheal deviation- Displacement of the Displacement of the trachea to one side or the othertrachea to one side or the other

HemoptysisHemoptysis- Coughing up of blood- Coughing up of blood Flail chest- Flail chest- Instability of a section of chest Instability of a section of chest

wallwall Paradoxical movement- Paradoxical movement- A condition in A condition in

which the injured area of the chest moves which the injured area of the chest moves opposite the rest of the chest during opposite the rest of the chest during breathingbreathing

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General First Aid Care Principles General First Aid Care Principles for Chest Injuriesfor Chest Injuries

Activate the EMS system immediately; then follow these Activate the EMS system immediately; then follow these steps:steps:

1. Your first priority is to open the airway if necessary; 1. Your first priority is to open the airway if necessary; ensure adequate ventilation. ensure adequate ventilation.

2. Place an occlusive dressing over any open wounds to the 2. Place an occlusive dressing over any open wounds to the chest; control external bleeding.chest; control external bleeding.

3. Never try to remove an impaled object; stabilize it to 3. Never try to remove an impaled object; stabilize it to prevent movement until the victim can receive medical prevent movement until the victim can receive medical help.help.

4. If there is an object impaled in the chest:4. If there is an object impaled in the chest:• • Cut away clothing to expose the wound.Cut away clothing to expose the wound.• • Dress the wound around the impaled object to control Dress the wound around the impaled object to control bleeding and control a sucking bleeding and control a sucking chest wound.chest wound.• • Stabilize the impaled object with rolls of self-adheringStabilize the impaled object with rolls of self-adheringbandages or bulky dressings.bandages or bulky dressings.• • Tape bandages in place to stabilize the impaledTape bandages in place to stabilize the impaledobject.object.

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PROGRESS CHECKPROGRESS CHECK

1. One of the two most important signs of chest injury 1. One of the two most important signs of chest injury is a change in ____________. is a change in ____________. (skin color/normal (skin color/normal breathing pattern)breathing pattern)

2. One of the two most important signs of chest injury 2. One of the two most important signs of chest injury is the ____________ rate. is the ____________ rate. (respiratory/heart)(respiratory/heart)

3. The first priority in caring for a victim of chest injury 3. The first priority in caring for a victim of chest injury is to ____________. is to ____________. (control bleeding/ensure adequate (control bleeding/ensure adequate ventilation/prevent further injury)ventilation/prevent further injury)

4. You should ____________ an impaled object in the 4. You should ____________ an impaled object in the chest. chest. (remove/stabilize, then remove/immobilize (remove/stabilize, then remove/immobilize and leave in place)and leave in place)

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9.2 Specific Chest Injuries9.2 Specific Chest Injuries

Flail ChestFlail ChestImmediately activate the EMS system; then:Immediately activate the EMS system; then:

1. Maintain an open airway and administer artificial 1. Maintain an open airway and administer artificial ventilation if the breathing is inadequate.ventilation if the breathing is inadequate.

2. Use 2. Use gentle gentle palpation to locate the edges of the flail palpation to locate the edges of the flail section; stabilize with a pad of dressings or a pillow. section; stabilize with a pad of dressings or a pillow. Secure with wide tape. Secure with wide tape.

3. Position the victim with the flail segment against an 3. Position the victim with the flail segment against an external support in a semi-sitting position or lying in external support in a semi-sitting position or lying in a supine position with the segment splinted with the a supine position with the segment splinted with the arm.arm.

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Compression Injuries and Compression Injuries and Traumatic AsphyxiaTraumatic Asphyxia

First Aid CareFirst Aid CareActivate the EMS system Activate the EMS system

immediately, then:immediately, then:1. 1. Maintain an open airway and Maintain an open airway and

administer artificial ventilation if administer artificial ventilation if breathing is inadequate.breathing is inadequate.

2. 2. Control any bleeding that results Control any bleeding that results from the trauma.from the trauma.

3. 3. Monitor the victim closely; Monitor the victim closely; position the victim in a supine position the victim in a supine position.position.

Signs and symptoms Signs and symptoms includeinclude::

Pale, cool, clammy skinPale, cool, clammy skin Weak pulsesWeak pulses Increased heart rateIncreased heart rate Increased breathing rateIncreased breathing rate Distended neck veinsDistended neck veins Bloodshot, protruding eyesBloodshot, protruding eyes Cyanotic tongue and lipsCyanotic tongue and lips Coughing or vomiting Coughing or vomiting

bloodblood

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Broken RibsBroken Ribs

First Aid CareFirst Aid Care

Activate the EMS system Activate the EMS system immediately, then:immediately, then:

1. Use a sling and swathe to utilize 1. Use a sling and swathe to utilize the victim’s arm as a splint and the victim’s arm as a splint and support the forearm of the injured support the forearm of the injured side positioned across the chest side positioned across the chest

2. Position the victim in a supine 2. Position the victim in a supine position.position.

3. Monitor the victim’s ABCDs, 3. Monitor the victim’s ABCDs, watching for signs of internal watching for signs of internal bleeding that could lead to shock.bleeding that could lead to shock.

Signs and symptoms Signs and symptoms include:include:

Severe pain at the fracture Severe pain at the fracture sitesite

Grating sound upon Grating sound upon palpation (crepitus)palpation (crepitus)

Chest deformityChest deformity Shallow, rapid breathingShallow, rapid breathing Bruising or lacerations at Bruising or lacerations at

the suspected fracture sitethe suspected fracture site Frothy blood at the nose or Frothy blood at the nose or

mouth (indicating lung mouth (indicating lung laceration)laceration)

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VocabularyVocabulary

Traumatic asphyxia-Traumatic asphyxia- Sudden compression of the Sudden compression of the chest wall that forces blood to flow the wrong way. chest wall that forces blood to flow the wrong way.

Crepitus-Crepitus- A sandpaperlike grating sound made by A sandpaperlike grating sound made by the ends of a broken bone as they rub togetherthe ends of a broken bone as they rub together

HemothoraxHemothorax- An accumulation of blood in the chest - An accumulation of blood in the chest cavitycavity

Tension pneumothorax-Tension pneumothorax- A situation in which air A situation in which air enters the pleural space through a oneway defect in enters the pleural space through a oneway defect in the lung, resulting in a progressive increase in the lung, resulting in a progressive increase in pressure in the pleural cavity that causes the lung to pressure in the pleural cavity that causes the lung to collapse and that impairs circulationcollapse and that impairs circulation

PneumothoraxPneumothorax- A condition in which air from a lung - A condition in which air from a lung or from the outside fills the chest cavity, but does or from the outside fills the chest cavity, but does not fill the lung. not fill the lung.

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PROGRESS CHECKPROGRESS CHECK

1. In flail chest, the chest wall ____________ when the victim 1. In flail chest, the chest wall ____________ when the victim exhales. exhales. (collapses/moves/protrudes)(collapses/moves/protrudes)

2. Flail chest most often occurs when multiple ____________ are 2. Flail chest most often occurs when multiple ____________ are fractured. fractured. (bones/ribs/joints) (bones/ribs/joints)

3. To check for flail chest, have the victim lie on his or her back 3. To check for flail chest, have the victim lie on his or her back and check for ________ as the victim breathes. and check for ________ as the victim breathes. (crepitus/pain/paradoxical motion)(crepitus/pain/paradoxical motion)

4. Traumatic asphyxia occurs from sudden ____________ of the 4. Traumatic asphyxia occurs from sudden ____________ of the chest wall. (compression/collapse/penetration)chest wall. (compression/collapse/penetration)

5. The most common symptom of rib fracture is ____________. 5. The most common symptom of rib fracture is ____________. (deformity/pain/bruising)(deformity/pain/bruising)

6. The greatest priority in treating rib fracture is to splint the 6. The greatest priority in treating rib fracture is to splint the chest so the victim ____________. (can breathe adequately/is not chest so the victim ____________. (can breathe adequately/is not in pain/will not be further injured by broken bone ends)in pain/will not be further injured by broken bone ends)

7. In treating a rib fracture, you should use ____________. 7. In treating a rib fracture, you should use ____________. (tape/continuous strapping/a sling and swathe)(tape/continuous strapping/a sling and swathe)

8. In a hemothorax, ____________ enters the chest cavity.8. In a hemothorax, ____________ enters the chest cavity.(air/blood/pressure)(air/blood/pressure)

9. To help prevent tension pneumothorax, you should always 9. To help prevent tension pneumothorax, you should always leave one corner of a chest bandage ____________. leave one corner of a chest bandage ____________. (over the wound/untaped/ at least (over the wound/untaped/ at least 2 inches beyond the wound)2 inches beyond the wound)

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9.3 Abdominal Injuries9.3 Abdominal Injuries

To assess a victim for abdominal injury:To assess a victim for abdominal injury:

1. Have the victim lie supine with knees flexed 1. Have the victim lie supine with knees flexed andand

supported; remove or loosen clothing over thesupported; remove or loosen clothing over the

abdomen.abdomen.

2. Inspect for lacerations, open wounds, 2. Inspect for lacerations, open wounds, bruising,bruising,

impaled objects, or protruding abdominal impaled objects, or protruding abdominal organs.organs.

3. Gently palpate all four quadrants for 3. Gently palpate all four quadrants for guarding, rigidity, pain, and tenderness.guarding, rigidity, pain, and tenderness.

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Signs and Symptoms of Abdominal Signs and Symptoms of Abdominal InjuriesInjuries

Distended or irregularly shaped abdomenDistended or irregularly shaped abdomen Bruising of the abdomen flank or backBruising of the abdomen flank or back Tenderness (pain on palpitation)Tenderness (pain on palpitation) Pain, ranging from mild discomfort to intense, intolerable painPain, ranging from mild discomfort to intense, intolerable pain Pain other than at the injury sitePain other than at the injury site Pain radiating to either shoulderPain radiating to either shoulder ““Guarding” (voluntary contraction of the abdominal muscles)Guarding” (voluntary contraction of the abdominal muscles) Fetal position or lying with legs drawn up toward the chest and abdomenFetal position or lying with legs drawn up toward the chest and abdomen Weak peripheral pulsesWeak peripheral pulses Abdominal crampingAbdominal cramping A rigid, boardlike, stiff or hard abdomen on palpationA rigid, boardlike, stiff or hard abdomen on palpation Nausea and/or vomiting; the victim may vomit bloodNausea and/or vomiting; the victim may vomit blood Rapid, shallow breathingRapid, shallow breathing Rapid pulseRapid pulse Open wounds and penetrationsOpen wounds and penetrations Organs protruding through open woundsOrgans protruding through open wounds Blood in the urineBlood in the urine Extreme weaknessExtreme weakness ThirstThirst Low blood pressureLow blood pressure

1515

General First Aid CareGeneral First Aid Care

1. Take measures to prevent shock; keep the victim warm, but do 1. Take measures to prevent shock; keep the victim warm, but do not overheat.not overheat.

2. Control bleeding and dress all open wounds with a dry, sterile 2. Control bleeding and dress all open wounds with a dry, sterile dressing. dressing.

3. If any object has penetrated or impaled the victim3. If any object has penetrated or impaled the victim• • Cut clothing away from the object.Cut clothing away from the object.• • Dress the wounds around the object to controlDress the wounds around the object to controlbleeding.bleeding.• • Stabilize the object with bulky dressings.Stabilize the object with bulky dressings.• • Bandage the object in place to preventBandage the object in place to preventmovement.movement.

4. Position the victim for greatest comfort; victims may want to lie 4. Position the victim for greatest comfort; victims may want to lie on the back with the knees flexed. If possible, elevate the feet.on the back with the knees flexed. If possible, elevate the feet.

5. Be alert for vomiting; position the victim for adequate drainage. 5. Be alert for vomiting; position the victim for adequate drainage. Constantly monitor vital signs and abdominal condition.Constantly monitor vital signs and abdominal condition.

6. Do not give the victim anything by mouth.6. Do not give the victim anything by mouth.

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Abdominal EviscerationAbdominal Evisceration

Activate the EMS system, then:Activate the EMS system, then:1. Cover protruding abdominal organs with a clean 1. Cover protruding abdominal organs with a clean

dressing moistened with sterile water if possible dressing moistened with sterile water if possible or clear water that is clean enough to drink. or clear water that is clean enough to drink.

2. Cover the moist dressing with an occlusive 2. Cover the moist dressing with an occlusive material, such as clean plastic wrap, to retain material, such as clean plastic wrap, to retain moisture and warmth. moisture and warmth.

3. Prevent shock, and constantly monitor the 3. Prevent shock, and constantly monitor the victim’svictim’s

vital signs.vital signs.

Never touch abdominal organs or try to replaceNever touch abdominal organs or try to replacethem in the abdominal cavity.them in the abdominal cavity.

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Rupture or HerniaRupture or Hernia

First Aid CareFirst Aid Care

Activate the EMS system immediately, Activate the EMS system immediately, then:then:

1. Position the victim on his or her back 1. Position the victim on his or her back

with the knees well drawn up, and with the knees well drawn up, and place a blanket or other padding under place a blanket or other padding under the knees.the knees.

2.2. Cover the victim with a blanket to Cover the victim with a blanket to preserve body warmth.preserve body warmth.

Never try to force a protrusion back Never try to force a protrusion back into the abdominal cavity.into the abdominal cavity.

Signs and symptoms Signs and symptoms include:include:

Sharp, stinging painSharp, stinging pain Feeling of something Feeling of something

giving way at the site giving way at the site of the ruptureof the rupture

SwellingSwelling Possible nausea and Possible nausea and

vomitingvomiting

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VocabularyVocabulary

EviscerationEvisceration- The protrusion of - The protrusion of abdominal contents through a abdominal contents through a laceration or other woundlaceration or other wound

HerniaHernia- Protrusion of an internal organ - Protrusion of an internal organ through the abdominal wall or into through the abdominal wall or into another body cavityanother body cavity

1919

PROGRESS CHECKPROGRESS CHECK

1. The amount of ____________ does not necessarily 1. The amount of ____________ does not necessarily indicate how serious abdominal injury is.indicate how serious abdominal injury is.

(pain/external blood/deformity)(pain/external blood/deformity) 2. Most abdominal injury victims are most 2. Most abdominal injury victims are most

comfortable on their back with the ____________. comfortable on their back with the ____________. (feet (feet elevated/head elevated/knees drawn up)elevated/head elevated/knees drawn up)

3. If abdominal organs protrude through a wound, 3. If abdominal organs protrude through a wound, you should ____________ them.you should ____________ them.

(cover/replace/remove)(cover/replace/remove)

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9.4 Injuries to the Genitalia9.4 Injuries to the Genitalia

Male GenitaliaMale Genitalia1. Wrap the penis or scrotum in a soft, sterile dressing moistened 1. Wrap the penis or scrotum in a soft, sterile dressing moistened

with sterile or clean water. with sterile or clean water. 2. If there is a penetrating or impaled object, do not remove it2. If there is a penetrating or impaled object, do not remove it3. If part of the penis or scrotum is caught in a zipper, cut off the 3. If part of the penis or scrotum is caught in a zipper, cut off the

zipper fastener and separate the teethzipper fastener and separate the teeth4. Apply an ice bag or cold compresses to relieve pain and reduce 4. Apply an ice bag or cold compresses to relieve pain and reduce

swelling.swelling.5. If there are avulsed parts, wrap in sterile gauze moistened with 5. If there are avulsed parts, wrap in sterile gauze moistened with

clean water and send them with the victim.clean water and send them with the victim.

Female GenitaliaFemale Genitalia1. Control bleeding with direct pressure.1. Control bleeding with direct pressure.2. Dress the wounds, keeping the dressing in place with a diaper-2. Dress the wounds, keeping the dressing in place with a diaper-

type bandage. Stabilize any impaled objects or foreign type bandage. Stabilize any impaled objects or foreign bodies.bodies.

3. Use ice packs or cold compresses to relieve pain and 3. Use ice packs or cold compresses to relieve pain and reduce swelling.reduce swelling.

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PROGRESS CHECKPROGRESS CHECK

1. In both male and female victims with injuries to the 1. In both male and female victims with injuries to the genitalia, apply ____________ to relieve pain and genitalia, apply ____________ to relieve pain and reduce swelling. reduce swelling. (direct pressure/an ice bag/sterile (direct pressure/an ice bag/sterile gauze)gauze)

2. Always try to ____________ avulsed skin.2. Always try to ____________ avulsed skin.

(preserve/finish detaching/clean)(preserve/finish detaching/clean)

3. If a woman was the victim of sexual assault, try to3. If a woman was the victim of sexual assault, try to

____________. ____________. (comfort her/find the assailant/preserve (comfort her/find the assailant/preserve the chain of evidence)the chain of evidence)