b. Monitor the casualty for pericardial tamponade. This condition, which will be
discussed later, is caused by penetrating chest wounds such as gunshot wounds or
stab wounds. The result of the condition can be diminished cardiac output and finally
death; therefore, it is extremely important to watch for signs of pericardial tamponade in
c. Keep the bronchial tree clear of retained blood, foreign material, and
bronchial secretions by using suction as needed.
d. Give oxygen to maintain adequate oxygenation and removal of carbon
dioxide. If oxygen administered by nasal catheter is inadequate, use tracheal
intubation, cricothyroidotomy, or controlled positive breathing.
e. Estimate the amount of hemorrhage the casualty has, and replace the blood
Section II. SPECIFIC CHEST INJURIES
FRACTURED RIBS OR STERNUM
a. Fractured Ribs. Fractured ribs are usually caused by blunt, direct blows or
compression injuries of the chest. The upper ribs are protected--in front by the clavicle,
in back by the scapulae, in the side by the arms, and by the heavy muscles of the upper
thorax and its appendages--and are rarely fractured. The fifth through the ninth ribs are
most commonly fractured. The lower two ribs are attached to the thoracic vertebrae
and have movement; therefore, they are rarely fractured.
b. Fractured Sternum. Fracture of the sternum occurs about once in every
twenty chest injuries. Sternum are an indication to look for other serious injuries
because a blow hard enough to fracture the sternum will often cause serious damage in
the thorax. Injuries associated with a fractured sternum include tracheal or bronchial
tears, ruptured diaphragm or esophagus, flail chest, and contusion of the myocardium
c. Signs/Symptoms of Fractured Ribs or Sternum.
Tenderness at the point where the casualty indicates pain.
Pain that worsens when the casualty breathes or coughs.
(3) The casualty may be protecting the affected side by leaning toward that
side with his hand protecting it or by splinting the affected side.