First Aid/Chest & Abdominal Injuries

First Aid

Introduction — Issues in Providing Care — Primary Assessment & Basic Life Support — Secondary Assessment — Circulatory Emergencies

Respiratory Emergencies — Soft Tissue Injuries — Bone & Joint Injuries — Environmental Illness & Injury

Medical Conditions & Poisoning — Advanced Topics — Appendices — Meta content

Injuries to the chest and abdomen can be difficult to recognize and treat, and many injuries can go unnoticed until they become very serious. The muscle and bones that serve to protect vital organs can also mask their injuries – or at worst contribute to them. It is important for the rescuer to consider injuries that lie beneath the skin.

In addition, the different organs react in different ways when subjected to trauma. Hollow organs (such as the bladder) tend to rupture, releasing their contents into the surrounding space. Solid organs (such as the liver) tend to tear instead, often bleeding at a slow enough rate to be overlooked.

Closed Chest Injuries

Closed Chest injuries can be inherently serious, as this area of the body houses many critical organs, such as the heart, lungs, and many blood vessels. Most chest trauma injuries should receive professional medical attention. Always call for an ambulance for any potentially serious chest injury.

Rib Injuries

A common result of trauma to the chest is damage to the victim's rib cage. The curved shape of the rib cage helps to deflect the force of some injuries, but damage to cartilage or the ribs themselves can still result. While a single broken rib can be very painful for the patient, a number of broken ribs can lead to other complications. A victim with broken ribs may take very shallow breaths without even noticing it, as their body tries to prevent the pain with taking a full breath.

When many adjoining ribs are broken in different places, a portion of the rib cage can move in the opposite direction the chest should. This is known as a "flail" segment, and can make breathing very painful and less effective.

Recognition

Trouble breathing
Shallow breathing
Tenderness at site of injury
Deformity & bruising of chest
Pain upon movement/deep breathing/coughing
Dusky or blue lips or nail beds
May cough up blood
Crackling feeling upon touching victim's skin (sounds and feels like "Rice Crispies")

Treatment

Assess ABCs and intervene as necessary
Call for an ambulance
Assist the victim into a position of comfort (typically seated upright, to avoid fighting gravity)
Conduct a secondary survey
Monitor patient's condition carefully
Be vigilant, keep alert for any changes
If a flail segment is suspected, tightly secure a bulky dressing (such as a tightly folded hand towel) to help stabilize the injury

Open Chest Wounds

An open pneumothorax or sucking chest wound – the chest wall has been penetrated (by knife, bullet, falling onto a sharp object...)

Recognition

An open chest wound – escaping air
Entrance and possible exit wound (exit wounds are more severe)
Trouble breathing
Sucking sound as air passes through opening in chest wall
Blood or blood-stained bubbles may be expelled with each exhalation
Coughing up blood

Treatment

Assess ABCs and intervene as necessary
Do not remove any embedded objects
Call for an ambulance
Flutter valve over wound, as described below
Lateral positioning: victim's injured side down
Treat for shock
Conduct a secondary survey
Monitor vitals carefully

Making a flutter valve

Get some sort of plastic that is bigger than the wound. Ideas: credit card or similar, Ziploc bag, some first aid kits will have a ready-to-use valve. Tape the plastic patch over the wound on only 3 sides. The 4th side is left open, allowing blood to drain and air to escape. This opening should be at the bottom (as determined by the victim’s position). When the casualty inhales, the bag will be sucked in, but when the casualty exhales, the air will exit through the untaped side.

Abdominal Injuries

Protruding organs

If a trauma injury has caused the victim's internal organs to protrude outside the abdominal wall, do not push them back in. Doing so will only cause greater complications - remember that preventing further injury is one of the aims of first aid.

Instead, have the person lie flat with their knees bent and cover the organs with a moist, sterile dressing composed of material that will not stick to the affected organs. Normally a special dressing, ABD Pad (Army Battle Dressing) or trauma dressing is used, though large Telfa dressing will work well. Gauze can stick if it is dry – be careful to keep normal gauze moist if you do use it. Paper products like paper towel or toilet paper must never be used, as they will turn to pulp, causing major complications. Do not allow the victim to eat or drink, though they may complain of extreme hunger or thirst. Call an ambulance, treat for shock, and monitor ABCs until the emergency medical team arrives.

Internal Bleeding

If the abdominal injury does not cause an open wound, have the person lie flat with their knees bent and treat for shock until EMS arrives.

Soft Tissue Injuries

Burns — Electrocution — Chest & Abdominal Injuries