• Chest Injury

    The chest cavity contains the heart, the major blood vessels that enter and leave the heart, the lungs, the trachea and most of the esophagus. These vital organs are protected by a bony cage formed by the ribs and breastbone (sternum). Chest injuries may involve the organs and major blood vessels housed in the chest cavity, the bones that form the chest cavity, or both.

    Traumatic chest injuries are frequently caused by blunt trauma. Penetrating trauma (e.g., a stab or gunshot wound) is also a common cause of traumatic chest injuries. Internal bleeding is likely when a person has sustained significant trauma to the chest.

    Signs and Symptoms of Chest Injuries

    A person with a broken rib may take small, shallow breaths because normal or deep breathing is uncomfortable or painful. The person usually will attempt to ease the pain by supporting the injured area with a hand or arm.

    Emergency Steps

    1

    Check the scene safety, form an initial impression, obtain consent and put on PPE, as appropriate.


    2

    Check for signs and symptoms.

    • Trouble breathing*
    • Fast heart rate*
    • Flushed, pale, ashen (gray) or bluish skin*
    • Severe pain or bruising*
    • Chest wall deformity*
    • Unusual chest wall movement (e.g., only one side moves)*
    • Coughing up bright red or dark, coffee-ground-like blood*
    • “Sucking” sound from the wound with each breath*
    • Signs and symptoms of shock*
    • Signs of broken rib(s): small, shallow, uncomfortable or painful breaths; support of injured area

    *Note: Signs and symptoms with a * require immediate emergency medical treatment.


    3

    Call 9-1-1 and get equipment if the person requires immediate emergency medical treatment.


    4

    Give Care.


    General Care

    1. Position person as appropriate.
      1. If a head, neck or back injury suspected, leave in position found unless you must move for safety, to perform CPR or to control bleeding.
      2. If signs and symptoms of shock, have person lie flat on their back unless they prefer a different position for comfort and breathing.
    2. Give care consistent with condition found and level of training.
    3. If a rib fracture suspected, give care for rib fracture.
    4. If there is a life-threatening or open chest wound, give care for life-threatening or open chest wound.
    5. Continue checking them as appropriate to determine if additional care is needed.
    6. Keep them from getting cold or overheated.
    7. Give care for shock, if necessary.
    8. Stay with them until EMS arrives.
    9. Reassure them you will help and that EMS has been called (if appropriate).
    10. Watch for changes in condition, including breathing and responsiveness, and give care as appropriate and trained.

    Chest Injury FAQs

    How do I position a person?

    Position a person as follows:

    • If a head, neck or back injury is suspected, leave them in the position found unless you must move them for safety, to perform CPR or to control bleeding.
    • If the person is responsive, allow them to assume a position of comfort.
    • If the person is unresponsive and breathing or responsive but not fully awake, place them in the recovery position.

    How do I place a person in the recovery position?

    To place an adult, child or infant in a recovery position:

    • Extend the person’s arm that is closest to you above the person’s head.
    • Roll them toward yourself onto their side, so that their head rests on their extended arm.
    • Bend both of the person’s knees to stabilize their body.

    Why are chest injuries a problem?

    Chest injuries may involve the organs and major blood vessels in the chest cavity, the bones that form the chest cavity or both. Traumatic chest injuries are often caused by blunt trauma. Penetrating trauma (e.g., a stab or gunshot wound) is also a common cause. Internal bleeding is likely when a person has significant trauma to the chest.

    How long should I apply direct pressure if there is bleeding?

    Hold direct pressure until:

    • The bleeding stops.
    • Another person relieves you.
    • You are too exhausted to continue.
    • The situation becomes unsafe.

    What is shock?

    Shock is a progressive, life-threatening condition in which the body does not get enough oxygen-rich blood often due to disturbed blood flow. As a result, organs and body systems begin to fail.

    Signs and symptoms include:

    • Rapid, weak heartbeat
    • Rapid breathing
    • Pale, gray or cool moist skin
    • Altered level of responsiveness
    • Excessive thirst

    Note: If you see any signs and symptoms of shock, call 9-1-1.

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