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Referencing the content of EMT-Basic training and emergency patient care

EMT Basic · Chapter 30

Chest Injuries

Learning objectives (11)

  1. Demonstrate the management of a patient with a sucking chest wound — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  2. Describe the complications of a patient with a flail chest — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  3. Describe the complications of cardiac tamponade — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  4. Describe the complications of rib fractures — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  5. Describe the differences between an open and closed chest injury — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  6. Describe the steps to take in the assessment of a patient with a suspected chest injury — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  7. Differentiate between a pneumothorax (open, simple, and tension) and a hemothorax — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  8. Explain the complications of a patient with an open pneumothorax (sucking chest wound) — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  9. Explain the mechanics of ventilation in relation to chest injuries — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  10. Recognize the complications that can accompany chest injuries — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.
  11. Recognize the signs of chest injury — Knowledge/skills objective (printed page 1091); confirm wording in your course copy.

Vocabulary (11)

Pneumothorax
Air in the pleural space causing partial or complete lung collapse.
Tension pneumothorax
A pneumothorax in which a one-way air leak progressively collapses the lung and shifts mediastinal structures, compromising circulation; an immediate threat to life.
Hemothorax
Blood in the pleural space, often from chest trauma; can cause respiratory compromise and shock.
Hemopneumothorax
The presence of both blood and air in the pleural space following thoracic trauma.
Flail chest
A free segment of chest wall created by fractures of two or more adjacent ribs in two or more places; produces paradoxical movement.
Pulmonary contusion
Bruising of lung tissue from blunt chest trauma; can lead to hypoxia over hours.
Cardiac tamponade
Compression of the heart by fluid in the pericardial sac; reduces cardiac output and causes obstructive shock.
Beck's triad
The classic findings of cardiac tamponade — hypotension, jugular venous distention, and muffled heart sounds.
Open chest wound (sucking chest wound)
A penetrating chest injury that allows air to enter the pleural space directly through the wound during inhalation.
Vented chest seal
An occlusive dressing with a one-way valve placed over an open chest wound to prevent air entry while allowing air to escape, reducing tension risk.
Paradoxical respirations
Inward chest wall movement during inhalation (opposite of normal) — characteristic of flail chest.

Sequence practice (2 puzzles on Quiz Me)

Recognition of tension pneumothorax

Order these findings from earliest to latest in a developing tension pneumothorax.

  1. Chest trauma plus increasing respiratory distress
  2. Unilateral diminished or absent breath sounds
  3. Hypotension and tachycardia
  4. Jugular venous distention
  5. Tracheal deviation away from the affected side (late sign)
Field management of an open chest wound

Order EMT steps for an open ('sucking') chest wound.

  1. Cover the wound with a gloved hand initially
  2. Apply a vented chest seal (or three-sided occlusive dressing per protocol)
  3. Provide high-flow oxygen; assist ventilations as needed
  4. Monitor closely for developing tension pneumothorax
  5. Rapid transport with ALS intercept if available

Quick fire sample (11 of 11 on Quiz Me)

Air in the pleural space causing partial or complete lung collapse.
  1. Pulmonary contusion
  2. Beck's triad
  3. Paradoxical respirations
  4. Pneumothorax
A pneumothorax in which a one-way air leak progressively collapses the lung and shifts mediastinal structures, compromising circulation; an immediate threat to life.
  1. Open chest wound (sucking chest wound)
  2. Pulmonary contusion
  3. Tension pneumothorax
  4. Vented chest seal
Blood in the pleural space, often from chest trauma; can cause respiratory compromise and shock.
  1. Hemopneumothorax
  2. Hemothorax
  3. Cardiac tamponade
  4. Paradoxical respirations
The presence of both blood and air in the pleural space following thoracic trauma.
  1. Open chest wound (sucking chest wound)
  2. Flail chest
  3. Hemopneumothorax
  4. Vented chest seal
A free segment of chest wall created by fractures of two or more adjacent ribs in two or more places; produces paradoxical movement.
  1. Paradoxical respirations
  2. Hemothorax
  3. Flail chest
  4. Cardiac tamponade
Bruising of lung tissue from blunt chest trauma; can lead to hypoxia over hours.
  1. Hemothorax
  2. Tension pneumothorax
  3. Pulmonary contusion
  4. Open chest wound (sucking chest wound)
Compression of the heart by fluid in the pericardial sac; reduces cardiac output and causes obstructive shock.
  1. Beck's triad
  2. Pneumothorax
  3. Vented chest seal
  4. Cardiac tamponade
The classic findings of cardiac tamponade — hypotension, jugular venous distention, and muffled heart sounds.
  1. Open chest wound (sucking chest wound)
  2. Beck's triad
  3. Tension pneumothorax
  4. Hemothorax
A penetrating chest injury that allows air to enter the pleural space directly through the wound during inhalation.
  1. Hemopneumothorax
  2. Open chest wound (sucking chest wound)
  3. Flail chest
  4. Paradoxical respirations
An occlusive dressing with a one-way valve placed over an open chest wound to prevent air entry while allowing air to escape, reducing tension risk.
  1. Beck's triad
  2. Pulmonary contusion
  3. Tension pneumothorax
  4. Vented chest seal
Inward chest wall movement during inhalation (opposite of normal) — characteristic of flail chest.
  1. Tension pneumothorax
  2. Hemopneumothorax
  3. Cardiac tamponade
  4. Paradoxical respirations

Some topics in this course differ across field references. See when sources disagree on Quiz Me before you teach from this sheet alone.

Full scored drills are on Quiz Me at /courses/nm-emt-b/chapters/30/print/. Answers are not marked on this sheet.