Ch. 11 - Chest, Abdominal, & Pelvic Injuries

Injuries to the chest, abdomen, and pelvis include both soft tissue injuries (e.g., internal organ damage) and fractures (e.g., of the ribs or pelvic bones). While ribs are thin and more susceptible to fractures, a powerful force (e.g., from a fall or motor vehicle collision) is required to cause serious injury to the pelvic bones.

Because the chest, abdomen, and pelvis contain many of the body’s vital organs, injuries to these areas can be immediately life-threatening. A force that causes a severe injury in these areas may also cause injury to the spine. All injuries described in this chapter should cause serious concern: Any patient with a serious chest, abdomen, or pelvic injury should be placed in the rapid transport category.

Transcript

1. Ch 11 – Pg 215
2. Chest, Abdomen, and Pelvis While ribs are thin and more susceptible to fracture, a powerful force is required to cause serious injury to the pelvic bones. Any patient with a serious chest, abdomen, and pelvic injury should be RTC, because they contain many of the body’s vital organs. General care includes controlling any external bleeding, limiting movement, and taking steps to mitigate shock. Ch 11 – Pg 215-216
3. Chest Injuries Occur when either a bunt or penetrating force is applied (ex: MVC, industrial accidents, falls, and intentional violence). The chest must be exposed for proper assessment. General Symptoms: • Respiratory distress or arrest • Pain at the site of the injury that increases with deep respirations • Obvious deformity • Unequal or paradoxical movement of the chest wall • Unequal movement: one side of chest moves more than the other • Paradoxical movement: a section of the chest moves in opposition from the rest of the chest • Flushed, pale or bluish skin • Coughing up blood Ch 11 – Pg 215-216
4. Rib Fractures Usually caused by an external blunt-force. Although painful, a simple rib fracture is rarely life-threatening. Multiple rib fractures are more serious and often cause internal hemorrhaging and difficulty breathing. Signs & Symptoms: • Respirations present as painful, shallow or laboured • The patient leans toward the side of the fracture • The patient tries to stabilize the fracture by putting pressure on the injured area
5. Treatment for Simple Rib Fractures 1. Position the patient to facilitate respiration 2. Support and immobilize the injured area using a soft, bulky object, such as a pillow or rolled blanket 3. Provide interventions for respiratory distress or arrest if indicated
6. Flail Chest Multiple rib fractures result in a section of the rib cage breaking free (a flail segment) • Leads to paradoxical movement Treatment: 1. Locate the flail segment via palpation 2. Stabilize with bulky dressing that extends beyond the edges of the segment 3. Secure with long strips of tape
7. Hemo- and Pneumothorax Hemothorax Bleeding into the pleural space around the lungs Pneumothorax Air entering the pleural space around the lungs Both the result of blunt or penetrating trauma Rapid Transport Category
8. Hemo- and Pneumothorax S&S – Hemothorax • Difficulty breathing Treatment • Supplemental oxygen • Assisted ventilations as necessary S&S – Pneumothorax • Difficulty breathing • Pain increased by coughing or inhaling deeply • Subcutaneous emphysema
9. Penetrating Chest Injuries Can injure any structure within the chest, including the lungs, heart, and major arteries or veins. The can range in severity from minor to life- threatening. You may hear a sucking sound coming from the wound with each inhalation (ie. a sucking chest wound). Rapid Transport Category
10. Care for Penetrating Chest Injuries Your goal is to control any external hemorrhaging without increasing the pressure in the chest • The concern is occluding the wound (air is no longer able to enter or exit) • Occlusion significantly increases the risk of pneumothorax 1. Apply direct pressure with your gloved hand and/or a non-occlusive dressing 2. Monitor the dressing closely and replace saturated dressing immediately to avoid occlusion
11. Abdominal Injuries Unlike the chest, the abdomen is not surrounded by a cage of bones and is more susceptible to injury Because it contains vital organs, injuries are often life- threatening • Severe internal bleeding • Severe infection
12. Abdominal Injuries S&S • Severe pain • Bruising • External bleeding • Nausea and vomiting • Pale, moist skin • Thirst • Tenderness or tight feeling • Abdominal distension • Pale, moist skin • Evisceration • S&S of shock Blunt trauma to the abdomen may not cause external signs of injury and may even be painless, even when serious injuries have occurred. You should suspect serious injuries if the MOI suggests they are likely; the patient should be Rapid Transport Category.
13. Treatment for Abdominal Injuries 1. Supine position 2. Bend the knees if it does not cause pain and place a rolled blanket or pillow under them 3. If external bleeding is present, apply trauma dressings and gentle pressure
14. Evisceration 1. Remove clothing from around the wound 2. Cover the area lightly with moist, sterile dressings placed loosely over the wound 3. Cover the dressings loosely with plastic wrap, if available 4. Place a folded towel or blanket over the area 1. If necessary, gently secure with large bandages Rapid Transport Category
15. Pelvic Injuries Blunt trauma or penetrating objects are the most common cause. Fractured bones can puncture/lacerate internal organs and major blood vessels. When assessing or treating, minimize movement or the pelvis, as any motion increases the risk of damage to internal structures. Rapid Transport Category • Pain • Pelvic instability (feeling like their coming apart) • Crepitus • Numbness in legs • Decreased range of motion • Paralysis • Rectal, urethral, or vaginal bleeding • Bruising
16. Treatment of Pelvic Injuries 1. Keep patient supine and avoid movement if possible 2. If it’s within your training, immobilize patient 3. Avoid putting pressure on the pelvis