Thoracic Injuries

The vital organs of the thoracic cavity

Heart

Lungs

Major vessels

Well protected by the rib cage

Takes high energy and velocity forces to cause injury

Anatomy
Assessment
Must be thorough, efficient, and focused on the
mechanism of injury.
Observe general appearance while determining level of
consciousness
Evaluating the ABCs (airway, breathing, circulation).
Valuable information regarding the severity of the
condition by:
Level of anxiety
Ability to speak in full sentences
Assessment
The mental status of the athlete is also important to

determine because alterations in mental status are the

first signs of hypoxia.
Any athlete with difficulty breathing and who is

unable to speak in full sentences needs emergent

referral to a hospital.
Assessment
Vital signs, including:
Blood pressure

Pulse oximetry

Pulse rate and quality

Skin color

Temperature

Quality and frequency of respirations

Assessment
Evaluating the quality of respirations; be alert for the
following:
Nasal flaring: the nostrils opening wide on inhalation
Tracheal tugging: the Adam’s apple is pulled upward on
inhalation
Retraction of the intercostal muscles on inhalation
Use of the diaphragm and neck muscles to assist inhalation
Use of abdominal muscles on exhalation
Cyanosis
Assessment
Auscultation of the lungs will determine the quality of

respirations and efficiency of air movement.

Should listen at each site during expiration and

inspiration for air movement.

Sites of auscultation
Assessment
Palpate the chest by gently placing hands on the rib cage
and feel for the rise and fall during breathing
Should be equal in motion, rate, and rhythm

Palpate the bony structures, looking for:

Deformity of the ribs
Unstable segments
Congruency of the sternoclavicular and costosternal joints
Presence of swelling, crepitus, or crackling of
subcutaneous emphysema
Assessment
Pain elicited by compressing the thorax front to back or inward
from the sides indicates the possibility of a fracture to the ribs
• Percuss the chest, indicate the density of the
underlying tissue
Normal: a resonant sound equal bilaterally
Hyperresonant: excessive air accumulating in the thorax as would
be present in the case of a pneumothorax
Dull: the presence of fluid in the lung such as in the case of a
hemothorax
Percussion
Assessment
Notice should be taken to:
Erythema

Ecchymosis

Deformity

Paradoxical movement

Alignment of the trachea

Assessment
In the case of an open wound, determine if air

movement in and out of the wound is present

Determining the presence of an exit wound would

Any injury to the thoracic cavity may lead to shock

either acutely or over time.

Observation of the skin color may be informative in

identifying the onset of shock

Assessment
Pale, ashen, or cyanotic coloring would be indicative

of respiratory collapse
Red, dark-red, or blue coloring of the head and neck

would be indicative of traumatic asphyxia

Types of Injuries
Fractures
Dislocation
Types of Injuries
Pneumothorax
Types of Injuries
The athlete will present with a sudden onset of a sharp
chest pain and difficulty breathing after exercising,
strenuous coughing, or even air travel.
Tension Pneumothorax
A pneumothorax that expands to the point where it
compresses on the aorta, heart, and superior and
inferior vena cava is called a tension pneumothorax and
is a life-threatening injury
Types of Injuries
If breathing sounds are absent on the affected side and
severe dyspnea and jugular vein distension are present,
then a tension pneumothorax should be immediately
suspected.
Affected athletes will appear anxious and restless,
hypotensive with a rapid and thready pulse, and on the
verge of circulatory collapse.
Percussion will result in hyperresonanceon the
affected side.
Types of Injuries
If the athlete is unconscious or unable to breathe
adequately, then assist respirations with a bag-valve
mask.
If the symptoms still do not improve, needle
decompression must be performed rapidly
Types of Injuries
Open Pneumothorax
The severity of this condition is dependent on the size
of the opening in the chest wall and the causative
agent such as a bullet, knife, or javelin.
Management of an open pneumothorax includes
administration of high-flow oxygen and monitoring of
vital signs, especially respiratory effort and efficiency.
Open Pneumothorax
Treatment of an open pneumothorax involves creating
a one-way valve with a dressing.
Covering the opening with a sterile occlusive dressing.
If significant improvement is not seen, endotracheal
intubation is indicated.
Hemothorax
Blood entering the pleural cavity results in a
hemothorax, and the mechanism is the same as a
pneumothorax.
If the lungs become compromised, the athlete will
develop dyspnea and chest pain and the jugular veins
will become distended
Effective treatment of a hemothorax includes oxygen
supplementation and respiratory support.
Intravenous fluid resuscitation is undertaken with
great care because an overload of fluid may result in
significant pulmonary edema and difficulty in
ventilation during the hospital course of treatment.
Rapid transport to a trauma center is essential.
Pulmonary Embolism
A blood clot that enters the venous system and lodges
in the lung results in a pulmonary embolism.
The clot blocks pulmonary circulation, and dead space
in the lung increases.
Symptoms of an acute pulmonary embolism include a
sudden onset of chest pain, dyspnea, tachycardia, and
bloody sputum.
Treatment includes early recognition, oxygen
administration, and rapid transport to the hospital