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Quick Chart
Introduction
- Injury occurring in the chest wall, lungs, pleura, thoracic great vessels, diaphragm, heart, trachea, bronchus and oesophagus.
Clinical Presentation
- Respiratory assessment will identify any impairment to ventilation including identify any:
- Tracheal deviation
- Wounds, bleeding or bruising
- Emphysema (surgical)
- Laryngeal crepitus
- Haemoptysis
- Venous engorgement
- Pneumothorax, tension pneumothorax, haemothorax or flail chest
Exclusion Criteria
Exclusion Criteria
Risk Assessment
- Adequate analgesia may improve ventilation by allowing improved chest wall expansion but high dose of opioids may induce respiratory depression.
Management
Primary Care
- Primary Survey with c-spine consideration
- Be aware of Trauma Management Principles
- Airway management/ventilatory support (as required)
- Oxygen therapy as per CPG
- Immobilisation of impaled objects and positioning (as required)
- Cover open chest wounds with an occlusive dressing taped down on three sides
- Secondary / CNS Survey
Intermediate Care (EMT / Level 2)
- Administer pain relief
- Consider applying cardiac monitor if trained and authorised
- Metropolitan crews should consider Major Trauma Bypass as per guideline
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
- Administer pain relief
- Consider cardiac monitoring
- Patients in cardiac arrest with suspected tension pneumothorax caused by trauma (with torso involvement) to receive needle thoracentesis as per clinical skill
- Metropolitan crews should consider Major Trauma Bypass as per guideline
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
Critical & Extended Care (CCP, PSO)
- Arrested and non-arrested patients with signs of pulmonary barotrauma and are suspected of having tension pneumothorax should receive surgical decompression by finger thoracostomy as per clinical skill
Additional Information
- Open chest wounds:
- Covering with an occlusive dressing taped on 3 sides only allow air to escape, but not enter the chest.
- If signs of respiratory distress worsen (indicating tension pneumothorax) try removing the dressing from the wound. If this does not help, treat as an absolute emergency and transport Priority 1 to hospital, notify the hospital en route.
- Impaled objects:
- Leave them in place and stabilise; seal around the base of the object with sterile dressings.
- Closed injury:
- Stabilise rib fractures with patient positioned towards injured side, in a position of comfort.
- Stabilise a flail sternum with the flat of a gentle supporting hand.
References
References
Document Control
Directorate
Clinical Services
Responsible Manager
Head of Clinical Services
Published Date
Review Date
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