What is EMS Chest Injury?
First responders, like paramedics, often come across people with chest injuries. These injuries account for almost a quarter of all deaths related to physical harm, just trailing behind head and neck injuries. Chest injuries need quick action to stabilize the patient, regardless if they’re caused by something sharp (like gunshot wounds, cuts, or punctures) or heavy impacts (like car accidents, falls, and explosions).
The main aim of emergency medical services (EMS) is to minimize the time it takes for a patient to get medical help after they’re injured. While the protocols vary a bit, all EMS providers generally follow the same guidelines laid out in the advanced trauma life support (ATLS) protocol.
Given the range and potential seriousness of chest injuries, it’s crucial to get the patient to the hospital as fast as possible. While paramedics can perform some interventions on the spot, studies have shown that patients typically do better when invasive procedures are carried out in a hospital setting.
In the United States, the help EMS provides at the scene usually includes basic life support and ATLS. This might involve managing a patient’s airway in a non-invasive way, performing CPR, using a defibrillator, controlling bleeding, immobilizing the spine, and stabilizing any broken limbs. More advanced techniques like putting a tube into a patient’s windpipe (endotracheal intubation), giving certain medicines, monitoring the heart, and relieving pressure in the chest with a needle (needle decompression) can also be used. Depending on the local resources and facilities, there might also be differences in the transportation services and the capabilities of the hospitals they’re taken to.
What Causes EMS Chest Injury?
Traumatic chest injuries can happen in two main ways – penetrating injuries and blunt injuries. Penetrating injuries include things like gunshot wounds, cuts, and punctures, while blunt injuries happen from things like car accidents, falls, getting crushed, blasts, and burns. Most of the time, chest trauma is due to blunt injuries.
Both types of injuries can lead to a variety of complications, including:
- Tension pneumothorax, which is when air leaks into the space between the lung and the chest wall, causing the lung to collapse.
- Open pneumothorax, a condition in which the chest wall is open to the outside, allowing air to enter the space around the lungs.
- Hemothorax, where blood collects in the chest, often due to a lung injury.
- Flail chest, which happens when a part of the chest wall becomes disconnected from the rest of the chest due to broken ribs.
- Pericardial effusion, where fluid builds up around the heart.
- Cardiac tamponade, a dangerous condition where fluid or blood builds up around the heart, preventing it from beating properly.
- Aortic rupture, or a tear in the major artery leaving the heart.
- Esophageal rupture, or a hole in the esophagus, the tube that connects your throat and stomach.
- Tracheal or bronchial tree rupture, which are tears in airways leading to the lungs.
- Myocardial or lung bruise, basically meaning a bruised heart or lung.
- Diaphragmatic rupture, which is a tear in the diaphragm, the muscle that helps us breathe.
Therefore, any chest injury should be taken very seriously and immediate medical help should be sought.
Risk Factors and Frequency for EMS Chest Injury
Chest injuries are linked to a significant number of trauma cases, be it from a hard blow or a piercing object. They account for a quarter of all deaths related to trauma. Though injuries to the thoracic aorta, the large blood vessel in your chest, are relatively rare, they are usually serious and could end badly.
- Chest injuries make up 14% of all hard blow trauma cases and 12% of all penetrating traumas.
- They account for about 25% of deaths from trauma-related causes.
- Injuries to the thoracic aorta, though uncommon, usually have negative outcomes.
Signs and Symptoms of EMS Chest Injury
Emergency Medical Services (EMS) personnel often receive incomplete details about a patient before they get to the hospital. Various factors like the patient’s state of health and the safety of the scene play a role in how much information can be gathered on the spot. Ideally, the EMS team should try to get a summary of what happened, a timeline, and the patient’s medical background, all while conducting a quick physical check.
If a patient cannot give these details due to their condition, family members or other bystanders could provide useful information. Things like how much blood has been lost (for instance, from gunshot wounds or stabbings), how long it took to remove the patient from the scene (like car crashes or building collapses), and any changes in consciousness or vitality during transport should all be told to the hospital team when they get there.
When the patient is in the hospital, a thorough history and physical exam are vital for determining the right treatment or whether further transport is needed. In situations where the patient can’t talk to the medical team, the physical exam is even more important than the medical history.
Testing for EMS Chest Injury
If you have been in a traumatic accident, it’s the job of emergency medical services (EMS) staff to examine you for injuries, stabilize your condition, and get you to a nearby hospital or trauma center as quickly as possible. They conduct an initial assessment known as the “ABC” evaluation, which checks your airway, breathing, and circulation. Even if you have a visible injury, they need to confirm these three vital functions are working correctly first. They will also monitor your vital signs and mental awareness often. EMS staff are trained to spot life-threatening conditions, make sure you can breathe, and get any severe bleeding under control.
Airway
The first step is to check your airway, making sure it’s open and functioning. They do this by talking to you or watching for physical signs. Injuries to your head, neck, or an altered state of consciousness could make this step trickier. If necessary, the EMS staff may keep your neck still as a precaution, provide extra oxygen, or use other methods to keep your airway clear.
Breathing
Next, the EMS staff check on your ability to breathe. They do this by observing your chest movements, listening to your breathing, checking the number of breaths you take and your oxygen level. They specifically look for signs of certain injuries like a punctured or collapsed lung, or a broken rib cage.
Circulation
It’s vital to check if your blood flow is normal, especially if you have chest trauma, as it could become life-threatening very quickly. The EMS staff will be checking your pulse and looking for signs of internal or external bleeding. They might need to apply pressure or a tourniquet to stop serious bleeding. If necessary, they will start an IV line for fluids as they transport you to the hospital, without any delays.
Apart from these checks, EMS staff also have to make sure the scene where they are treating you is safe. They might need to shout for help, evaluate if the area is free from danger, or move you if necessary. They also have to think about how to best use their resources if there are multiple injured people at the scene.
Although it can be challenging to spot severe chest injuries straight away, there are things like abnormal chest movements or difficulties listening to the chest due to surrounding noise which can complicate matters. As a result, the EMS staff will be highly alert for signs of serious hidden injuries.
Also, in some parts of the world, ultrasound machines are used by EMS providers to help diagnose patients with trauma injuries more accurately, but this isn’t the case everywhere. Ultrasounds can help identify chest conditions like trapped air in the chest or fluid around the heart more rapidly and reliably. However, more research is needed to prove if using ultrasound in pre-hospital settings reduces complications or death rates in trauma patients.
Treatment Options for EMS Chest Injury
Chest injuries can lead to several complications, some of which may need immediate medical attention. If any severe conditions are detected during the initial examination, it’s crucial to act promptly before further assessments. Some conditions require quick, non-surgical interventions followed by transferring the patient as fast as possible to an appropriate healthcare facility. Once the patient is stable, the main goal of Emergency Medical Services (EMS) is to transport the patient to the right place at the right time. EMS plays a significant role in managing trauma due to the urgency of such injuries.
Tension Pneumothorax
A tension pneumothorax occurs when air progressively builds up in the chest cavity, causing pressure to increase and gradually compress the lungs and heart. This happens when a “one-way valve” effect allows air to enter the chest cavity, but not to leave. As the amount of trapped air increases, the pressure rises, causing the lung on the impacted side to collapse and squeeze the lung on the other side. The heart gets shifted away from this trapped air, leading to reduced blood flow back to the heart. If not treated timely, even a minor pneumothorax can evolve into a life-threatening condition called obstructive shock.
Common signs of tension pneumothorax include shortage of oxygen, rapid heart rate, rapid breathing, low blood pressure, tracheal deviation (or a shift in the windpipe) away from the injured side, and reduced breath sounds on the injured side.
To stabilize the patient, EMS can perform a procedure called needle decompression. This involves poking a wide-bore needle into the chest cavity on the injured side, providing a route for the trapped air and pressure to escape. However, this method is often a temporary solution as the needle can often get blocked or stuck within the muscles. In a hospital setting, more definitive procedures like the insertion of a chest tube or a pigtail catheter (a small flexible tube) potentionally can be used to allow air to escape from the chest cavity.
Open Pneumothorax
An open pneumothorax is a type of chest injury where a wound allows air to freely enter the chest cavity during inhalation but significantly obstructs air from exiting during exhalation. An open pneumothorax often leads to tension pneumothorax if left untreated. Immediate intervention, such as applying a special type of bandage that only allows air to escape and not enter the chest cavity, is necessary. This provides some temporary relief until the patient can receive proper treatment in the hospital.
Flail Chest
A flail chest arises when several adjacent ribs break in two or more places, detaching a section of the rib cage. This detached part moves inwards during inhalation and outwards during exhalation, a phenomenon known as “paradoxical breathing”. High-impact forces that can cause multiple rib fractures may also bruise the lung. To stabilize the patient during transport, EMS providers can apply pressure to the detached part of the rib cage to prevent under-ventilation (not being able to breathe properly).
Other Conditions
Chest trauma can lead to a wide range of conditions, from minor to life-threatening. In the absence of specific protocols for severe conditions like pericardial tamponade (fluid accumulation around the heart), massive hemothorax (large amount of blood in the chest cavity), aortic rupture (rupture of the main artery from the heart), diaphragmatic tear (tear in the muscle that separates the chest and abdomen), and esophageal injury (damage to the food pipe), EMS providers focus on stabilizing basic life functions and ensuring the patient is transported to the hospital as fast as possible.
What else can EMS Chest Injury be?
If you have a chest injury, your doctor might evaluate you for a variety of conditions such as:
- Tension pneumothorax (collapsed lung due to trapped air)
- Open pneumothorax (penetrating chest wound leading to collapsed lung)
- Hemothorax (blood accumulation in the chest)
- Flail chest (a serious condition set by multiple rib fractures)
- Pericardial effusion (fluid around the heart)
- Cardiac tamponade (fluid pressure on the heart)
- Aortic rupture (a break in the major artery)
- Tracheal or bronchial tree injury (damages to the airways)
- Myocardial contusion (bruising of the heart muscle)
- Pulmonary contusion (bruising of the lung)
- Diaphragmatic rupture (a tear in the diaphragm)
- Esophageal rupture (a tear in the esophagus)
What to expect with EMS Chest Injury
Chest injuries can have severe consequences and can often result in a high level of illness or even death. The seriousness of a chest injury, additional injuries outside of the chest area, and preexisting medical conditions greatly influence the chances of survival. Most people with blunt traumatic aortic injuries – which is when the main artery from your heart gets damaged due to a sudden and violent blow to your chest – may not survive long enough to reach a hospital or a standalone emergency facility.
However, prompt evaluation, immediate stabilization of the patient’s condition, and effective technical intervention or medical procedures can notably improve survival rates. Age plays a factor too, as older patients generally have a higher risk and worse outcomes.
Possible Complications When Diagnosed with EMS Chest Injury
Chest injuries can cause various complications that may impact different organs within the chest. These complications often require an X-ray or surgical exploration to diagnose and treat accurately. A common serious complication of both sharp and blunt chest injuries is what we call “tension pneumothorax.” This condition can put your life in danger if not treated promptly. Another significant problem following a traumatic chest injury is complications related to the lungs.
Patients with a specific type of injury called “flail chest” may experience an odd movement of the ribs, which can make it hard to breathe. This condition can contribute to respiratory failure – when the body cannot get enough oxygen or cannot remove enough carbon dioxide.
The common complications could be summarised as:
- Complications related to lungs and other chest organs
- Tension pneumothorax – A life-threatening condition
- Respiratory failure due to unusual rib movements
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Preventing EMS Chest Injury
Teaching the public about ways to prevent chest injuries could help decrease the number of such injuries. People who are present at the scene of an accident or injury are crucial because they can quickly start and keep up life-saving measures for injured individuals until emergency medical services (EMS) get there.