Chest Trauma
Disorders
Signs and Symptoms
1. Pain in the chest after blunt chest trauma
2. Pain that worsens with inspiration
3. Point tenderness over the fractured rib(s)
4. Crepitus and deformity, occasionally detected on palpation
5. Fractured ribs usually occur along the side of the chest. Pushing on the sternum while the patient lies supine will produce pain at the fracture site, instead of at the point of contact
Treatment
1. Care for any open chest wounds.
a. Cover the wound quickly, especially if there is air bubbling, to avoid “sucking” chest wound (see Open [“Sucking”] Chest Wound, later).
b. Use a petrolatum-impregnated gauze, heavy cloth, or adhesive tape for the dressing.
2. Treat an isolated rib fracture.
a. Administer an oral analgesic, and instruct the patient to rest.
b. Note that thoracic taping and splinting are contraindicated so that the patient can take full unimpeded inspirations.
c. Encourage the patient to cough or deep-breathe at least 10 times per hour to prevent atelectasis.
3. Treat multiple rib fractures.
a. Be aware that multiple fractures are associated with higher risk for serious underlying injuries.
b. Cushion the patient in a position of comfort, and frequently reevaluate the patient’s ability to breathe.
c. Do not tape or tightly wrap the ribs because this might prevent complete reexpansion of the lung with inspiration, leading the patient to take only shallow, inadequate breaths and possibly leading to atelectasis and pneumonia. Provide analgesics so that the patient may take at least 10 deep breaths or give one good cough every hour.
d. Evacuate the patient as soon as possible. If the chest injury is on one side, transport the patient with the injured side down to facilitate lung expansion and oxygenation of the blood on the uninjured side.
Flail Chest
Treatment
1. Immediately arrange for evacuation of the patient. A small or moderate flail segment can be tolerated for 24 to 48 hours, after which it may need to be managed with mechanical ventilation.
2. Administer intercostal nerve block(s) (Fig. 15-1) to assist in short-term management of pain and pulmonary toilet.
