What is Chest Trauma (Hits to the Chest)?

Chest trauma, which includes everything from minor rib fractures to severe damage to chest organs, is a serious problem in emergency medicine. Common causes are accidents, falls, assaults, and car crashes. It’s the second most common type of accidental injury, and the third leading cause of death in patients with multiple injuries. Some research shows that chest injuries result in the highest fatality rate, contributing up to 60% of deaths. A quarter of severe trauma deaths are due to these injuries.

Given the life-threatening potential of chest trauma, it’s very important to quickly identify and appropriately respond to this condition. This will help to prevent complications and improve patients’ chances of survival and recovery.

Understanding the anatomy of the chest area is crucial in effectively managing these injuries. The chest, or thoracic cavity, contains the sternum, ribs, and thoracic vertebrae that offer critical protection to the organs inside. It contains a central compartment called the mediastinum, which houses important structures like the heart, major blood vessels, windpipe, esophagus, and lymph nodes.

The primary organs for breathing, the lungs, are within the chest. They play a key role in the exchange of gases, providing oxygen to the blood and eliminating carbon dioxide. Right in the heart of the mediastinum is the heart, which circulates oxygenated blood throughout the body.

Major blood vessels ensure systemic and lung circulation. They include the aorta, pulmonary artery, upper and lower vena cava, and pulmonary veins. The windpipe and bronchial tree allow air to flow from the throat to the bronchi inside the lungs, where crucial air exchange occurs. The diaphragm, a muscle that separates the chest and abdomen, helps with breathing by alternately contracting and relaxing.

Next to the trachea, the esophagus transports food and liquid from the mouth to the stomach. The space between the two layers of pleura, the thin membranes that line the lungs and chest cavity, contains a small amount of fluid that allows the lungs to move smoothly during breathing. The various nerves in the chest area play key roles in sensation, motor function, and the regulation of important processes like heart contraction, breathing, and digestion.

What Causes Chest Trauma (Hits to the Chest)?

Chest injuries can happen due to penetrating or non-penetrating trauma. Non-penetrating trauma is more common and can be life-threatening. The cause of injury helps doctors decide on the best course of initial and follow-up care. This includes deciding what kind of imaging tests should be used and when a surgeon needs to be consulted.

Car accidents are the top cause of chest trauma. They’re also the main cause of most sudden injuries to the aorta, the main artery in your body. Physical compression or a sudden slowdown is usually how these injuries happen. Open pneumothorax, where air fills the space between the chest wall and lung due to a hole in the chest, is usually connected to gunshot injuries.

Risk Factors and Frequency for Chest Trauma (Hits to the Chest)

Chest trauma, or injury to the chest, is a common problem that can affect people of all ages. According to a 2016 report, chest injuries have the highest death rate when compared to injuries in other parts of the body. The most common cause of these severe chest injuries is a motor vehicle crash (MVC). Among these injuries, lung bruising is more frequently found in children, while rib fractures are less common. A condition called pneumothorax, which is the presence of air in the chest cavity that can lead to lung collapse, happens in 30% of chest trauma cases.

Studies show that approximately 36% of trauma-related deaths in the United States could potentially be prevented. Of these, 41% are due to thoracic, or chest, injuries. Most of these injuries (80 to 92%) are caused by blunt trauma, or direct impact. Causes of these preventable deaths often include delays in treatment, incorrect management of the injuries, and medical misjudgement

It’s important to note that elderly patients often face higher risks than younger ones with similar injuries. If they have a single rib fracture, their risk of death is twice as high as younger people with the same injury. For each additional fractured rib, the risk of death increases by 19% and the risk of pneumonia, a lung infection, increases by 27%. Children, on the other hand, are more likely to develop hypoxia, a condition where the body or a region of it does not receive enough oxygen, especially when their strength is diminished or their functional reserve is used up.

Signs and Symptoms of Chest Trauma (Hits to the Chest)

People who suffer from chest injuries may experience issues like difficulty breathing, loss of consciousness, and a faint heartbeat. Rapid assessment and swift medical intervention are vital in such cases. The medical team will first check the person’s airway, breathing, circulation, responsiveness, and exposure – a process known as the primary survey. Lifesaving procedures will start immediately, focusing on treating severe injuries, such as stopping significant bleeding. Once the patient is stable, doctors can conduct a more detailed secondary survey to further assess the person’s injuries.

Patients with chest injuries may report certain symptoms such as chest pain, difficulty breathing, coughing up blood, rapid heartbeat, or a feeling of pressure or tightness in the chest. If the injury is severe enough to cause extensive bleeding or heart injury, the patient might also report feeling dizzy, nauseated, and sweaty. If the patient has sustained multiple injuries, they might also have pain, deformities, and loss of function in other parts of the body as well. Individuals with injuries to the esophagus often report difficulty swallowing, painful swallowing, and vomiting blood. They might also feel pain in their chest or back. If the patient loses consciousness, it might be due to severe blood loss, oxygen deprivation, or accompanying brain injury.

Knowing how the injury happened can also help doctors treat it. Chest trauma often results from car accidents, falls, assaults, or being wounded by an object. It’s important for doctors to know certain details about the incident like the direction and force of the impact. If the accident happened in a car, the investigating medical team will also consider factors like the extent of damage to the vehicle, whether the airbag deployed, and the presence of damage to the steering wheel to gauge the potential severity of the injury. The patient’s medical history, including whether they have conditions like diabetes, heart disease, lung disease, and kidney disease, can also affect how their injuries are managed. Substance use, occupational hazards, and lifestyle elements can all factor into the assessment and management of their injuries.

During a physical examination, doctors look for signs of life-threatening injuries. Some typical conditions they will look for include:

  • Obstruction or rupture of the airway
  • Tension pneumothorax (a life-threatening condition where air collects between the lung and the chest wall)
  • Cardiac tamponade (pressure on the heart caused by fluid buildup)
  • Massive hemothorax (accumulation of blood in the space between the chest wall and the lung)
  • Flail chest (a severe chest injury in which multiple ribs are broken causing a part of the chest to collapse)

After the initial exam and the patient’s condition is understood better, a secondary survey may reveal conditions such as:

  • Rib fractures
  • Small hemothorax
  • Small pneumothorax
  • Contusions or bruises on the lung or chest wall

Certain serious injuries may initially be hidden, but suspicion for these should always remain high. These might include:

  • Injury to the windpipe or main airways
  • Injury to the aorta
  • Myocardial contusion (a bruise on the heart muscle)
  • Lung contusion (a bruise on the lung)
  • Rupture of the diaphragm
  • Rupture of the esophagus

Patients with severe blood loss, long-term lack of oxygen, or serious head injury might be unconscious. In conscious patients, rapid heartbeat, rapid breathing, low blood pressure, and low oxygen levels could suggest instability in their condition. Rapid heart rhythms could also be a sign of blood loss or injury to the heart muscle. Disruption of the aortic root can cause rapid death due to excessive blood loss and the subsequent blood filling around the heart.

When conducting a physical examination, doctors will look for signs of bruising, abrasions (like the “seat belt sign”), and puncture wounds. In some cases, if the patient is anxious or refusing to cooperate, they may have been drinking alcohol. Diminished or reduced breath sounds might suggest the presence of a hemothorax or pneumothorax. During the physical examination, the doctor will listen to the patient’s breathing, look for tenderness in the chest, and check for the presence of air in the chest cavity by feeling for crepitus (a crackling sensation under the skin).

Patients with a tension pneumothorax will be experiencing breathing difficulties, rapid breathing, and low oxygen levels. In these cases, the breath sounds will be diminished or absent in certain parts of the chest, and the neck veins may be swelling. However, even if the neck veins are not swollen, that doesn’t necessarily rule out the presence of a tension pneumothorax.

A lung contusion, which can cause hypoxia, should also be suspected in patients with chest wall injuries. The level of hypoxia will usually depend on the size of the contusion.

Physical examinations should always include a look for other injuries that might have occurred alongside the chest trauma. This includes things like a detailed vascular examination, which will check for pulses and blood pressure in both the upper extremities. For patients who were initially unconscious but have now been stabilized, a complete neurological examination is also needed.

Testing for Chest Trauma (Hits to the Chest)

To diagnose chest trauma, doctors use various techniques including imaging scans, laboratory tests, and physiological studies. These help to quickly identify any damage, assess risk, and plan the best way to treat the patient. The selection of diagnostic tests depends on each patient’s specific situation.

One common method is a chest X-ray. This can be done at the bedside for most patients with trauma injuries. However, for a condition like tension pneumothorax, doctors usually rely on the symptoms and physical signs rather than waiting for an X-ray. If this condition is suspected, doctors will try to release the pressure in the chest immediately. Even though an X-ray can’t always identify tension pneumothorax, a bedside ultrasound scan has been shown to be accurate in diagnosing it.

Sometimes, smaller pneumothoraces (collapsed lungs) and hemothorax (blood in the chest) might not be seen in an X-ray taken while the patient is lying down. Doctors might suspect an aortic injury if an X-ray shows signs like a widened mediastinum (the space in the chest between the lungs), aortic knob loss, or the left main bronchus moving away from the midline.

In addition to X-rays, ultrasound scans are often used in trauma cases. An extended sonography assessment, also known as e-FAST, can check for pneumothorax and hemothorax. If there’s a collection of black fluid outside of an organ, this could indicate free fluid in the area, usually blood. The e-FAST exam can also evaluate the areas between the ribs on the chest wall for signs of pneumothorax. Doctors also look at the “spinal stripe” for signs of hemothorax.

Not to be left out, computed tomography (CT) scans are also used due to their high level of accuracy and detail, especially for injuries deep within the chest. They can help to identify serious injuries more effectively. However, these scans are only appropriate for patients who are stable. A spiral CT scan should be used to assess for a potential aortic injury in patients with high impact trauma.

Blood tests are essential too. They can provide information on things like anemia, signs of infection or inflammation, clotting problems, and the patient’s blood group. They can also measure arterial blood gas which helps assess respiratory function, and things like cardiac enzymes, and blood glucose levels.

An electrocardiogram (ECG) is used to check for any heart damage. It helps identify rhythm disturbances, heart muscle damage and conduction difficulties. However, just because an ECG is normal doesn’t mean there’s no heart damage. Further evaluations might be needed.

Lastly, there are additional tools doctors might use like endoscopy and bronchoscopy to check for injuries to the esophagus and lungs respectively. And it’s important to remember that chest trauma rarely happens in isolation. Other associated injuries might be present, some of which can be challenging to diagnose, making it important to keep an open mind to all potential injuries.

Treatment Options for Chest Trauma (Hits to the Chest)

After an injury, it’s important to immediately focus on stabilizing key areas like the airway, breathing, and circulation. In life-threatening situations, such as large air or blood leaks in the chest (known as pneumothoraces and hemothorax), urgent action like a chest tube thoracostomy (CTT), which enables draining the fluids, is needed. If a patient has a pneumothorax, they need to be given a mask providing 100% oxygen followed by possible CTT if the condition is severe. In the case of hemothorax, it is crucial to ensure all the blood is removed from the chest cavity to prevent infections.

Whilst surgery is usually not needed for chest injuries, it should not be delayed if it’s necessary. Indications for surgery could include excessive drainage from a chest tube, continuing low blood pressure despite blood transfusion, or particular scenarios associated with hidden air leaks. Patients with certain conditions like multiple rib fractures, lung bruising, fluid or air in the chest, low oxygen levels, or pre-existing lung disease should be admitted to the hospital and monitored closely.

Controlling the pain is vital for preventing complications like pneumonia, and can be achieved using short-acting painkillers or more focused methods like nerve blocks, pain-relief patches, intravenous or epidural painkillers. Patches that don’t contain narcotics are a good option for ongoing chest wall pain, even without confirmed rib fractures, or before discharging a patient.

Research has shown that preventative antibiotics for chest tubes do not prevent pneumonia or chest infection and should perhaps not be given routinely for all chest injuries, given the risk of antibiotic resistance and potential side effects.

Patients needing surgery must be identified carefully. Open reduction and internal fixation can help notably by reducing deaths, ventilator use, and hospital stays in patients with a flail chest (a segment of the rib cage breaks under extreme stress and becomes detached). Treatment of lung contusions, or bruising should aim at preventing respiratory problems and may benefit from physical therapies like postural drainage, deep breathing, and coughing exercises. Positive pressure ventilation can aid in serious cases, though caution should be taken to avoid excessive ventilation pressure which can lead to injury. Drugs that reduce blood pressure within the lungs and careful fluid balance can also be beneficial.

In more severe cases, surgical correction can be needed to stabilize multiple rib fractures or improve lung function. Extracorporeal gas exchange, a technique to oxygenate and remove carbon dioxide from the blood outside of the body, can be a successful method for treating severe lung injuries. Certain injuries to the aorta may also require surgical repair.

The severity of aortic injuries determines the management; mild injuries may be managed conservatively, while more severe injuries require monitoring or immediate intervention. Lastly, injuries to the esophagus need to be treated quickly to prevent serious infections and swallowing problems.

People experiencing chest trauma could be suffering from various health conditions, and doctors need to consider all the possibilities when making a diagnosis:

  • Heart attack: Symptoms like chest pain radiating to the left arm or jaw, shortness of breath, sweating, and nausea, especially in people who are already at risk, can signal a heart attack, which can sometimes be triggered by extreme stress or serious bleeding.
  • Pneumonia: Increased chest pain when coughing or taking deep breaths together with fever, coughing up phlegm, and signs of difficulty breathing can point to pneumonia.
  • Blood clot in the lungs: Sudden sharp chest pain that gets worse with deep breathing, shortness of breath, rapid breathing, and signs of shock can indicate a blood clot in the lungs. Those who are not very active or have blood clotting disorders are at a higher risk.
  • Aortic dissection: Severe, sudden chest pain that spreads to the back, with symptoms like shortness of breath, low blood pressure, and signs of heart valve leakage or peripheral ischemia could be signs of aortic dissection, which is when the inner layers of the aorta tear.
  • Tension gastrothorax: This is where the stomach herniates into the chest cavity, causing chest pain and difficulty breathing due to lung tissue compression and mediastinal shift.
  • Pericarditis: It’s a condition when the sac-like covering around the heart (pericardium) gets inflamed. Deep breathing or lying flat worsens the chest pain, which can also come with symptoms like shortness of breath, fever and a pericardial friction rub sound captured on stethoscope.
  • Anxiety or panic attack: Chest pain, racing heart, and rapid breathing can surface following chest trauma due to psychological distress.
  • Musculoskeletal pain: Chest pain that intensifies with movement or touch and isn’t linked to trouble breathing can point to a musculoskeletal issue, like an injury to the chest wall.

A meticulous clinical assessment alongside diagnostic tests can help accurately diagnose the actual cause of chest trauma.

What to expect with Chest Trauma (Hits to the Chest)

The effects of chest trauma can vary, based on how severe the injury is. For example, if someone just breaks a rib, they usually have a good chance of recovering. But if the lungs or heart are injured, it can take a lot longer to recover.

Injuries to the thoracic aorta, a large blood vessel, are very serious, and can lead to death. In fact, many people with such injuries might die before even reaching the hospital, and among those who do make it to the hospital, many pass away within 24 hours.

Both young and old people are most likely to face grave outcomes after chest trauma. It’s also worth noting that chest trauma is one of the main causes of death among children.

Possible Complications When Diagnosed with Chest Trauma (Hits to the Chest)

Chest injuries can lead to various complications including the likes of pneumonia, a severe kind of respiratory distress syndrome, lung injuries, infection of the space between the lungs, abnormal connection between arteries and veins, and formation of an abnormal passage between the lung and the pleural cavity. These issues may occur as a result of the injury itself or due to related critical injuries.

Common Complications:

  • Pneumonia
  • Acute Respiratory Distress Syndrome
  • Acute Lung Injury
  • Mediastinitis (infection of the space between the lungs)
  • Arteriovenous Fistula (abnormal connection between arteries and veins)
  • Bronchopleural Fistula (formation of an abnormal passage between the lung and the pleural cavity)

Preventing Chest Trauma (Hits to the Chest)

The prevention of chest injuries involves two main strategies. The first one, known as primary prevention, aims to reduce the chances of traumatic events occurring in the first place. This can be achieved by focusing on reducing risk factors and promoting safety. For example, enforcing the use of seatbelts and helmets, encouraging safe driving practices, applying speed limits, and lessening exposure to violence or fights. Further, maintaining safety standards at work, like using correct protective gear in jobs with higher risk, can prevent chest injuries related to work.

The second strategy, called secondary prevention, focuses on lessening the impact of injuries when traumatic events do happen. This involves ensuring quick access to emergency medical services, providing effective care before the patient reaches the hospital, and teaching the public how to perform first aid. By giving priority to these injury prevention measures at an individual, community, and wider societal level, the number and severity of chest injuries can be significantly lowered.

Frequently asked questions

Chest trauma refers to a range of injuries to the chest, including minor rib fractures and severe damage to chest organs. It is a serious problem in emergency medicine and can be caused by accidents, falls, assaults, and car crashes. Chest trauma is the second most common type of accidental injury and the third leading cause of death in patients with multiple injuries.

Chest trauma is a common problem that can affect people of all ages.

Signs and symptoms of chest trauma (hits to the chest) include: - Difficulty breathing - Loss of consciousness - Faint heartbeat - Chest pain - Coughing up blood - Rapid heartbeat - Feeling of pressure or tightness in the chest - Dizziness - Nausea - Sweating - Pain, deformities, and loss of function in other parts of the body (if multiple injuries are sustained) - Difficulty swallowing - Painful swallowing - Vomiting blood - Pain in the chest or back - Loss of consciousness (due to severe blood loss, oxygen deprivation, or accompanying brain injury) During a physical examination, doctors look for signs of life-threatening injuries such as: - Obstruction or rupture of the airway - Tension pneumothorax (air collects between the lung and the chest wall) - Cardiac tamponade (pressure on the heart caused by fluid buildup) - Massive hemothorax (accumulation of blood in the space between the chest wall and the lung) - Flail chest (multiple broken ribs causing a part of the chest to collapse) After the initial exam, a secondary survey may reveal conditions such as: - Rib fractures - Small hemothorax - Small pneumothorax - Contusions or bruises on the lung or chest wall Certain serious injuries may initially be hidden but should always be suspected, including: - Injury to the windpipe or main airways - Injury to the aorta - Myocardial contusion (bruise on the heart muscle) - Lung contusion (bruise on the lung) - Rupture of the diaphragm - Rupture of the esophagus Other signs and symptoms that may indicate instability in the patient's condition include: - Rapid heartbeat - Rapid breathing - Low blood pressure - Low oxygen levels - Rapid heart rhythms (sign of blood loss or heart muscle injury) - Disruption of the aortic root (can cause rapid death due to excessive blood loss) During a physical examination, doctors will also look for signs of bruising, abrasions, and puncture wounds. They will listen to the patient's breathing, check for tenderness in the chest, and feel for crepitus (a crackling sensation under the skin) to check for the presence of air in the chest cavity. Patients with tension pneumothorax may experience breathing difficulties, rapid breathing, and low oxygen levels. The breath sounds may be diminished or absent in certain parts of the chest, and the neck veins may be swelling. A lung contusion, which can cause hypoxia, should be suspected in patients with chest wall injuries. The level of hypoxia will depend on the size of the contusion. Physical examinations should also include a look for other injuries that might have occurred alongside the chest trauma, such as a detailed vascular examination to check for pulses and blood pressure in both upper extremities. For patients who were initially unconscious but have now been stabilized, a complete neurological examination is also needed.

Chest trauma can occur due to various causes such as car accidents, falls, assaults, being wounded by an object, and gunshot injuries.

Heart attack, pneumonia, blood clot in the lungs, aortic dissection, tension gastrothorax, pericarditis, anxiety or panic attack, musculoskeletal pain.

The types of tests that a doctor would order to properly diagnose chest trauma include: 1. Chest X-ray: This can be done at the bedside and is used to identify damage and assess risk. It may not always identify certain conditions like tension pneumothorax, but a bedside ultrasound scan can be used for accurate diagnosis. 2. Ultrasound scans: An extended sonography assessment (e-FAST) can check for pneumothorax and hemothorax. It can also evaluate the areas between the ribs on the chest wall for signs of pneumothorax and look for signs of hemothorax. 3. Computed tomography (CT) scans: These scans are used for injuries deep within the chest and can help identify serious injuries more effectively. They are appropriate for stable patients and can be used to assess for potential aortic injuries in patients with high impact trauma. 4. Blood tests: These tests provide information on anemia, signs of infection or inflammation, clotting problems, blood group, arterial blood gas, cardiac enzymes, and blood glucose levels. 5. Electrocardiogram (ECG): This test is used to check for heart damage, rhythm disturbances, heart muscle damage, and conduction difficulties. 6. Endoscopy and bronchoscopy: These tools are used to check for injuries to the esophagus and lungs, respectively. It is important to keep an open mind to all potential injuries as chest trauma rarely happens in isolation.

Chest trauma, such as hits to the chest, is treated by immediately focusing on stabilizing key areas like the airway, breathing, and circulation. Urgent action may be needed in life-threatening situations, such as large air or blood leaks in the chest, through procedures like a chest tube thoracostomy (CTT) to drain fluids. Patients with certain conditions may need to be admitted to the hospital and closely monitored. Pain control is vital to prevent complications, and various methods like short-acting painkillers or nerve blocks can be used. Preventative antibiotics for chest tubes are not recommended routinely. Surgery may be necessary in some cases, such as for stabilizing multiple rib fractures or improving lung function. Severe lung injuries can be treated with extracorporeal gas exchange. Injuries to the aorta or esophagus require appropriate management and treatment.

When treating chest trauma (hits to the chest), there can be several side effects. These include: - Pneumonia - Acute Respiratory Distress Syndrome - Acute Lung Injury - Mediastinitis (infection of the space between the lungs) - Arteriovenous Fistula (abnormal connection between arteries and veins) - Bronchopleural Fistula (formation of an abnormal passage between the lung and the pleural cavity)

The prognosis for chest trauma (hits to the chest) can vary depending on the severity of the injury. If someone only breaks a rib, they usually have a good chance of recovering. However, if the lungs or heart are injured, it can take longer to recover and the prognosis may be more serious. Injuries to the thoracic aorta, a large blood vessel, are particularly serious and can lead to death, with many people dying before reaching the hospital.

You should see an emergency medicine doctor or a trauma surgeon for chest trauma.

Join our newsletter

Stay up to date with the latest news and promotions!

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

We care about your data in our privacy policy.