Chest Trauma

Tips for Recognizing and Treating Common Chest Injuries

(c) Werner Vermaak

Chest trauma can be penetrating or blunt. If the injury pokes through the skin (stabbing, gunshot wound, 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. Some blunt forces can still break the skin -- getting kicked by a horse comes to mind -- but tearing the skin is not considered penetrating trauma.

Car accidents and falls cause the most blunt chest trauma. Gunshot wounds cause the most penetrating trauma.

Broken Ribs

woman wrapped around chest
Wrapping broken ribs makes the rescuer feel like they've done something, but doesn't help the patient at all.. Jupiterimages / Getty Images

Few things in this world hurt as much as broken ribs. Ribs provide the entire structure of the chest wall. Without ribs, we wouldn't be able to breath. When ribs break, it results in pain and difficulty breathing.

Unfortunately, there's not a lot you can do for simple broken ribs. Traditionally, the injury was wrapped with a bandage. The pressure is thought to help with the pain. You know what really helps? Morphine.

Flail Chest

cold compress on lower chest
Flail chest treatment is to support the broken ribs.. PhotoAlto / Alix Minde / Getty Images

A flail chest is broken ribs with an attitude. When something hits you hard enough to break off a section of ribs and leave them dangling only by the surrounding meat, you've got a section of spareribs flailing back and forth opposite of the rest of the ribcage. It hurts as bad as it sounds, as well as being potentially deadly.

Pneumothorax (Collapsed Lung)

Collapsed right lung x-ray
X-ray of a right lung pneumothorax.. 33karen33 / Getty Images

I'm not really a fan of the term collapsed lung. It's not as if you can poke a hole in a lung and let all the air out like a balloon. Instead, air trapped in the chest pushes the lung flat. Enough air will not only push the lung flat, but it will push it over, against the heart and the other lung. This video explains it.

Sucking Chest Wound

military man gunshot wound to the chest
Assume all penetrating trauma to the chest sucks.. powerofforever / Getty Images

Most people agree, having a hole in your chest sucks. No really, it sucks air in the wrong way. A sucking chest wound can lead to a collapsed lung (see above). It also makes creepy little bubbles in the hole.

In the obvious cases, you can hear the air sucking in. In more subtle cases, you just have to assume. It's a good idea to treat every hole in the chest as if it is a sucking chest wound.

Gunshot Wound

man with gunshot wound to chest being injured.
A Bangkok policeman receiving treatment for a gunshot wound to the chest in 2013.. Rufus Cox / Getty Images

Drop a rock in a pond and it makes a splash. Shoot a bullet into the body and it makes a splash, too. The difference is that after a few minutes, the pond will look the same, but the body stays messed up. Some of this is covered in How to Treat a Sucking Chest Wound, but gunshot wounds really do have a mind of their own.

Shortness of Breath

man with an oxygen mask
Shortness of breath is a mainstay of heart attack.. Vstock LLC / Getty Images

There are three really important organs in the chest: one heart and two lungs. That means gnarly chest trauma has better than a 65% chance of interfering with breathing or blood pressure. Internal injuries in the chest can interrupt blood flow, air flow or both.

There are types of trauma that aren't covered here, but the most important thing is to make sure your patient has a pulse and can breathe. Here's how to tell if breathing is a problem.

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