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Chest Injuries, Blunt

One-fourth of all trauma deaths in the United States result from chest injuries. Many are blunt chest injuries, which include myocardial contusion and rib and sternal fractures that may be simple, multiple, displaced, or jagged. Such fractures may cause potentially fatal complications, such as hemothorax, pneumothorax, hemorrhagic shock, and diaphragmatic rupture.

Causes

Most blunt chest injuries result from motor vehicle accidents. Other common causes include sports and blast injuries.

Signs and symptoms

• Difficulty breathing, failure of the chest to expand normally, crunching sounds in the ribs, bruising, and coughing up blood indicate a chest injury.
• One segment of the chest wall may not move with breathing or move opposite to the rest of the chest wall (flail chest).
• Even without an obvious external injury, a significant internal injury can occur.

Diagnosis

A history of trauma with dyspnea, chest pain, and other typical clinical features suggest a blunt chest injury. A physical examination and diagnostic tests determine the extent of injury.

• Percussion reveals dullness in hemothorax and tympany intension pneumothorax.
• Auscultation may reveal a change in position of the loudest heart sound in tension pneumothorax.
• Chest X-rays may confirm rib and sternal fractures, pneumothorax, flail chest, pulmonary contusions, lacerated or ruptured aorta, tension pneumothorax, diaphragmatic rupture, lung compression,or atelectasis with emothorax.
• ECG may show abnormalities with cardiac damage, including multiple premature ventricular contractions, unexplained tachycardias; atrial fibrillation, bundle-branch heart block (usually right), and ST-segment changes.

Treatment

Blunt chest injuries call for immediate physical assessment, control of bleeding, maintenance of a patent airway, adequate ventilation, and fluid and electrolyte balance.

• An object that remains in the chest injury should not be removed.
• The injured person should be positioned with the injured side down.
• The neck and back of the injured person should be immobilized after a possible chest injury.
• An airtight dressing such as tin foil or a plastic sack should be used as quickly as possible to cover any hole that extends into the chest cavity.