Page 26 - 2026 SMOG

CHEST TRAUMA
Signs and Symptoms
• Difficulty breathing
• Rapid respirations with SpO decreasing or <90% (In flight and on O )
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2
• Flail chest
• Unequal rise and fall
• Open wound/impalement over the thorax
• Penetrating abdominal wound
• Bruising across the chest or base of the neck
• Subcutaneous emphysema or deviated trachea
Treatment
• Penetrating chest wound
˚ Open
■ Seal open wound with occlusive chest seal (vented)
˚ Impalement
■ Stabilize
■ High index of concern for hemopneumothorax
˚ Signs of hemopneumothorax
■ Needle thoracostomy
˚ Goal: SpO ≥90%; improved RR; equal rise/fall
2
• Blunt chest trauma
˚ Flail chest
■ Administer pain control
■ Consider endotracheal intubation, positive pressure ventilation
˚ Signs of hemopneumothorax
■ Needle thoracostomy
˚ Goal: SpO ≥90%; improved RR; equal rise/fall
2
Notes, Cautions, Warnings
• Repeat needle thoracostomy if needed
• Failure to improve after needle thoracostomy
˚ Controlled descent as able
˚
Consider finger/tube thoracostomy
• Consider spinal immobilization for chest trauma patients
• Maintain a high index of suspicion for intra-abdominal and retroperitoneal bleeding in all
chest injuries
Reference: TCCC Guidelines; CPG ID #74 (Wartime Thoracic Injuries)

18 • TRAUMA