What is a penetrating chest injury?
Penetrating chest injuries (PCIs) are caused by an object puncturing the chest wall. Penetrating chest injuries can be high velocity, such as with gunshot wounds (GSWs); medium velocity, such as with pellet gunshots; or low velocity, such as with stab wounds.
How does the location of the wound affect penetrating chest trauma?
Although the force of the injury is a critical predictive factor in penetrating chest trauma, the location of the wound is also significant. A simple stab wound, depending on location, can cause greater injury than does a peripheral gunshot wound. For example, a stab to the chest can cause a laceration to the trachea and subclavian artery.
What is a chest injury?
Chest injuries are injuries to the chest wall (the bones, skin, fat and muscles protecting your lungs, including your ribs and sternum) or any of the organs inside the chest. Chest injuries can be minor, such as bruising, or serious problems that need urgent medical attention. One of the most common chest injuries is fractured ribs.
What is the difference between Blunt and penetrating chest trauma?
While penetrating chest trauma is less common than blunt trauma, it can be more deadly. Quick thinking and early interventions are key factors for evaluations, management, and survival. Chest trauma has quickly risen to be the second most common traumatic injury in non-intentional trauma.[1]
What are the effects of penetrating trauma on the body?
Penetrating trauma often causes damage to internal organs resulting in shock and infection. The severity depends on the body organs involved, the characteristics of the object, and the amount of energy transmitted. Assessment includes x-rays, CT scans, and MRI.
What happens in chest injury?
Chest injuries include: bruising or abrasions to the chest area. broken bones — for example, a rib fracture or fractured sternum (breastbone) flail chest — where multiple ribs next to each other are broken and that segment of the chest wall moves separately to the rest.
What are the most common injuries caused by penetrating chest trauma?
Hemothorax, pneumothorax, and a combination of these two injuries are the most common fatal complications of penetrating and blunt chest traumas.
What are the complications of chest injuries?
Although there are a wide range of complications following thoracic trauma, respiratory failure, pneumonia, and pleural sepsis are the most common potentially preventable problems. Respiratory failure and pneumonia are directly related to the severity of the injury and the age and condition of the patient.
How do you treat a penetrating chest injury?
Chest Injury TreatmentCall 911.Begin CPR, if Necessary.Cover an Open Wound.Stop Bleeding, if Necessary.Position Person to Make Breathing Easier.Monitor Breathing.Follow Up.
What are 3 types of chest injuries?
Types of chest injuries according to their locationContusions or bruises.Rib fractures.Flail chest.Esternal and scapula fractures.Clavicle fractures.
How can a penetrating chest injury be Recognised?
Signs to look for include:Severe shortness of breath.Unequal chest (one side looks bigger than the other)Tracheal movement to the uninjured lung.Veins on the neck bulging.Blue lips and neck (lack of oxygen)No lung sounds on one side.
How can a chest wound impair breathing?
Air that enters through a penetrating wound or a rupture in the lung tissue can create an actual space (pneumothorax) that results in the loss of negative pressure during inspiration. This can cause part of the lung to collapse and stop exchanging carbon dioxide and oxygen causing a ventilatory mismatch.
What are the two types of chest injuries?
Chest trauma can be penetrating or blunt. If the injury pokes through the skin (stabbing, gunshot wound, an arrow through the heart, etc.) we call it penetrating chest trauma. If a sharp object tearing deep into skin and muscle isn't the main cause of tissue damage, consider it blunt chest trauma.
What's the 6 immediate life threats in chest trauma?
The Lethal Six (airway obstruction, tension pneumothorax, cardiac tamponade, open pneumothorax, massive hemothorax, and flail chest) are immediate, life-threatening injuries that require evaluation and treatment during primary survey.
How long does it take to recover from a chest injury?
As a rough guide, fractured ribs and sternums take about 4-6 weeks to heal and it is usual to still feel some discomfort after this time. Bruising can take between 2-4 weeks to heal. Taking deep breaths and coughing are important normal actions that our bodies do every day.
What does a chest injury feel like?
Pressure, fullness, burning or tightness in your chest. Crushing or searing pain that spreads to your back, neck, jaw, shoulders, and one or both arms. Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity. Shortness of breath.
What does a chest injury feel like?
Pressure, fullness, burning or tightness in your chest. Crushing or searing pain that spreads to your back, neck, jaw, shoulders, and one or both arms. Pain that lasts more than a few minutes, gets worse with activity, goes away and comes back, or varies in intensity. Shortness of breath.
How long do chest injuries take to heal?
As a rough guide, fractured ribs and sternums take about 4-6 weeks to heal and it is usual to still feel some discomfort after this time. Bruising can take between 2-4 weeks to heal. Taking deep breaths and coughing are important normal actions that our bodies do every day.
What are the types of chest injury?
The common types of chest injuries are damaged blood vessels, organ contusion or laceration, pneumothorax, haemothorax and rib fractures.
How long does a chest muscle strain take to heal?
Your strength and motion may be mildly affected, and recovery usually only lasts between two and three weeks. A Grade 2 injury indicates more extensive damage to the chest that affects a higher amount of muscle fibers without completely rupturing the muscle.
What are the injuries to the chest?
Chest injuries are injuries to the chest wall (the bones, skin, fat and muscles protecting your lungs, including your ribs and sternum) or any of the organs inside the chest. Chest injuries include: bruising or abrasions ( cuts and grazes) to the chest area. broken bones (for example, a rib fracture)
What are chest injuries?
Chest injuries are injuries to the chest wall (the bones, skin, fat and muscles protecting your lungs, including your ribs and sternum) or any of the organs inside the chest.
What are the symptoms of chest injuries?
Signs of chest injury can vary, depending on the type of injury. The most common signs and symptoms are:
How are chest injuries diagnosed?
A chest injury is diagnosed with a physical examination and sometimes investigations such as a chest x-ray. A blood test may also be done. A CT scan may also be needed to check for injury to the heart.
What is the most common chest injury?
Chest injuries can be minor, such as bruising, or serious problems that need urgent medical attention. One of the most common chest injuries is fractured ribs.
How to diagnose a chest injury?
A chest injury is diagnosed with a physical examination and sometimes investigations such as a chest x-ray. A blood test may also be done. A CT scan may also be needed to check for injury to the heart. For a rib fracture, sometimes doctors can feel the broken ribs when they gently press the affected area.
How to treat a chest injury?
Treatment of the chest injury will depend on the cause of the injury and how serious it is. The medical team will support breathing and circulation if necessary. You may be given oxygen and intravenous fluids or blood transfusions. If you have a severe chest injury, you will be admitted to the hospital.
What is a penetrating chest injury?
Penetrating chest injuries (PCIs) are caused by an object puncturing the chest wall. Penetrating chest injuries can be high velocity, such as with gunshot wounds (GSWs); medium velocity, such as with pellet gunshots; or low velocity, such as with stab wounds. Penetrating chest injuries have a higher mortality rate than blunt chest injuries but are less common. Performing the standardized trauma evaluation (primary and secondary surveys), as well as ordering proper imaging, is critical to determining the diagnosis and aiding in management decisions. The majority of PCIs do not require major surgery and can be managed by observation or tube thoracostomy, although surgical repair of injuries may be needed.
How is chest trauma standardized?
While the initial approach to stabilizing a patient with chest trauma is standardized by performing the primary and secondary surveys, further imaging and testing are dependent on the injury discovered during the initial assessment .
What is hemothorax in a symtom?
Hemothorax: collection of blood in the pleural cavity. Usually occurs following chest trauma, which leads to lung laceration or damage to intercostal arteries. Symptoms include shortness of breath and chest pain. Signs include hypotension, tachycardia, decreased air entry, tracheal deviation, and dullness on percussion. Management is chest tube insertion. Thoracotomy may be indicated.
What is an emergency thoracotomy?
Emergency thoracotomy should be considered in all penetrating chest wounds leading to cardiac arrest. Bombs or IEDs create penetrating and blast injury. Bullet may not travel along a straight pathway. All potential injuries should be considered despite the point of entry (e.g., GSW to arm travels into chest).
What is chest x-ray indicated in?
Chest X-ray: indicated in all hemodynamically stable patients
What is the fatality rate of cardiac penetration?
Traumatic cardiac penetration has a fatality rate of 70%–80%.
How to make pain localized and reproducible?
Pain localized and reproducible by taking deep breaths
Examples of Penetrating Chest Injuries
If a foreign object enters the chest cavity in a traumatic accident, several severe injuries could result. Some of these examples include:
Treatment of Penetrating Injuries of the Chest
If someone presents at the emergency room following a motor vehicle accident, a thorough physical exam will take place. If an individual has suffered a penetrating injury of the chest, emergency treatment will begin. This could include:
Contacting a Personal Injury Attorney
Injuries of the chest always need to be taken seriously. Damage to the heart and lungs could place someone in an emergency situation in the blink of an eye. As a loved one recovers from these devastating injuries, it is essential for families to ask for help. It is a good idea to meet with a personal injury lawyer in Sacramento.
Sacramento Personal Injury Attorneys
I’m Ed Smith, a Personal Injury Lawyer in Sacramento. If someone suffers a penetrating injury to the chest, they could end up with life-threatening injuries that require emergency medical care.
How to assess a patient's injuries?
A complete assessment to define the patient’s injuries occurs during the secondary survey and includes taking a history of the injury, a medical history, identifying known allergies and medications taken, as well as the patient’s most recent meal. This information can be gathered from emergency medical service (EMS) personnel, the patient’s family, and bystanders at the scene of the incident. Since many patients with penetrating chest trauma are victims of violence, collection of forensic evidence is important. Collect clothing and place each article in a separate paper bag. Avoid cutting through bullet or knife holes on clothing and retain any bullets and weapons found. Promptly notify law enforcement officials according to local regulations.
How does hemothorax affect the respiratory system?
Massive hemothorax affects both the respiratory and circulatory systems. The accumulation of a significant amount of blood in the thorax causes hemorrhagic shock and can compress the lungs, which impedes breathing and oxygen exchange. Hemorrhage results from damage to any of the intercostal, pulmonary, or major vessels of the chest, or from direct lung or cardiac injury.
Why is understanding the mechanism of injury important?
An understanding of the mechanism of injury is critical when caring for patients with penetrating chest injuries, as it guides resuscitative efforts . Because these injuries impair airway patency, breathing, and circulation, maintaining a high degree of vigilance is crucial.
How to diagnose tension pneumothorax?
Diagnosis of tension pneumothorax is made by clinical observation, and in patients in extreme distress, decompression must be performed immediately and is accomplished by perpendicular insertion of a large-bore iv catheter into the second intercostal space, at the midclavicular line on the affected side. If this is successful, a rush of air will be heard through the catheter, and the patient’s vital signs will stabilize. A Heimlich flutter valve can be connected to the catheter and secured in place until a chest tube is inserted. Definitive management of the pneumothorax is completed with a closed thoracostomy tube connected to water seal drainage and suction.
What is low energy injury?
Low-energy injuries are sustained from stabbings and slashings. Although the force of the injury is a critical predictive factor in penetrating chest trauma, the location of the wound is also significant. A simple stab wound, depending on location, can cause greater injury than does a peripheral gunshot wound.
Why is it important to identify the location of all injuries?
It’s particularly important to identify the location of all injuries, and to do this, the patient should be completely exposed so that none are overlooked. Though not completely correlative, the pattern of wounds may help predict underlying injuries. Look closely at the axillae and perineum for concealed injuries. Descriptions of entrance and exit wounds should be made only by the forensic experts, as inaccurate ones may adversely affect any legal proceedings that may ensue.
Where to perform initial intervention in unstable patients?
In unstable patients, the initial intervention needs to be performed in the emergency department and surgery in the operating room. Since reaccumulation of blood is possible, the patient must be monitored for deterioration. Massive hemothorax affects both the respiratory and circulatory systems.
What is chest injury?
A chest injury can occur as the result of an accidental or deliberate penetration of a foreign object into the chest. This type of injury can also result from a blunt trauma, leading to chest wall injury which causes: rib bruises, fracture, lung or heart contusions.
Which side should the injured person be positioned with?
The injured person should be positioned with the injured side down.
What should be used to cover a hole in the chest cavity?
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. The injured person should be positioned with the injured side down. The injured person should be given pure oxygen to breathe.
What does it mean when you have difficulty breathing?
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).
Can one segment of the chest wall move with breathing?
One segment of the chest wall may not move with breathing or move opposite to the rest of the chest wall (flail chest).
What is a sucking chest wound?
An open pneumothorax, sometimes referred to as a "Sucking Chest Wound", involves the penetration of the integrity of the chest wall. Upon inspiration, the expansion of the chest cavity means the air pressure inside the thorax is below the atmospheric pressure, and air is "sucked" into the chest cavity through the wound.
What does it mean when your chest is unequal?
Unequal chest rise and fall, paradoxical motion, or chest deformity which can indicate underlying rib fractures
What is the term for a condition in which air leaks into the chest cavity through a defect in the lung?
A pneumothorax is any a condition in which air leaks into the chest cavity through a defect in the lung, the chest wall, or both, and collects in the pleural space. Understanding the pathophysiology of the pneumothorax can help you interpret the physical findings and understand the effects of certain interventions.
What is a commercial chest seal?
Special purpose commercial chest seals usually have an adhesive to secure to the chest wall and a ventilation valve that will allow air to escape and not re-enter. These may be too bulky to place on the patient's back if the patient is to be transported supine.
Why does the lung collapse?
As air leaks into the pleural space, the chest wall is no longer able to pull on the surface of the lung during inspiration, and the lung has a tendency to collapse due to its elastic recoil with a similar reduction in oxygenation to an open pneumothorax. Tension pneumothorax.
What is a collapsed lung called?
Patient Exam. In a patient with blunt or penetrating chest trauma, you may encounter a collapsed lung, called pneumothorax, or a significant amount of blood in the chest cavity, called a hemothorax.
Why does my lung make a sucking noise?
For fairly large wounds, as air passes back and forth through the open wound it will create a sucking noise. The collapse of the lung on the injured side reduces the volume of air that flows into the lung, and compromises the patient's ability to oxygenate the blood and remove carbon dioxide.
What is a penetrating trauma?
Supporting Author (s): Penetrating trauma is an injury caused by a foreign object piercing the skin, which damages the underlying tissues and results in an open wound. The most common causes of such trauma are gunshots, explosive devices, and stab wounds.
What percentage of penetrating injuries are male?
Males constituted a majority of persons with penetrating injuries, particularly when caused by firearms (88%) and explosives (80-85%). Two-thirds of penetrating injuries (66%-67%) occurred to persons age 18-44, even though this age group represents on 36% of the population.
What are the most common causes of trauma in the US?
The most common causes of penetrating trauma in the US are gunshots and stabbings. One recent study found approximately 40% of homicides and 16% of suicides by firearm involved injuries to the torso. 1 As recently as 2003, the US led in firearms-related deaths in all economically developed countries. 2.
Why do people get blunt injuries to their chest?
The vast majority of blunt injuries to the thorax are due to vehicular accidents, although other forms of trauma from various sports or falls may also cause such injury. Blunt traumatic injury to the chest may result in a variety of clinical conditions 2:
What is a penetrating injury?
Penetrating injuries can be broadly divided into high-velocity mechanisms, typically caused by gunshots or other missiles, or low-velocity mechanisms, typically associated with sharp objects such as knives, axes, and glass. This distinction is important because of the different underlying mechanisms of cerebrovascular injury and the vastly greater extent of tissue damage seen with high-velocity penetrating trauma.
How to repair a penetrating aorta?
Penetrating injuries to the thoracic aorta are usually treated with urgent surgical repair via an anterolateral thoracotomy. Endovascular repair with stent grafts may be possible for penetrating injuries in selected patients (see TAI section).
What is the most common mechanism of upper extremity vascular injury?
Penetrating trauma is the most common mechanism in upper extremity vascular injury. A penetrating mechanism of injury in military series is greater than 90% routinely, and consists of explosive shrapnel and high-velocity gunshot wounds.
How does high velocity trauma affect cerebrovascular injury?
High-velocity penetrating trauma can induce cerebrovascular injury-based predominantly on three underlying mechanisms: (1) direct soft tissue injury, (2) shock wave effects, and (3) thermal injury. Direct soft tissue injury occurs due to direct contact with the penetrating object, such as when a bullet passes through blood vessels, or by the creation of bony fracture fragments, which can act as secondary projectiles ( Moeng and Boffard, 2002; Steenburg et al., 2010 ). Shock wave effects result from the dissipation of kinetic energy into the soft tissues surrounding the penetrating trajectory, as well as the associated cavitation. Thermal injury to blood vessels can be caused by the intrinsically high temperatures of many projectiles.
What causes a penetrating trauma?
Penetrating trauma involving the ureter occurs in approximately 4% of patients and is most often caused by a stab or gunshot wound.
What causes a thoracic injury to be punctured?
Most penetrating thoracic injuries are due to missile or knife wounds, but the intrathoracic organs are occasionally punctured by a bony fragment resulting from nonpenetrating trauma.