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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
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
Key Terms & Links
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Clinical Services

Responsible Manager
Head of Clinical Services

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