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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.
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