Chapter 13Chest, Abdominal, and

Pelvic Injuries

Chest Injuries

• Open or closed• All victims should have their airway,

breathing, and circulation checked.• A responsive victim should sit up or

be placed with injured side down.

Closed Chest Injuries

In a closed chest injury, the skin is not broken.

Rib Fractures

• The upper four ribs are protected by the collarbone and shoulder blades.

• The lower two ribs, “floating ribs,” have freedom to move.

• Broken ribs usually occur along the side of the chest.

Recognizing Rib Fractures• Sharp pain (deep breath, coughing, or moving)• Victim holds injured area. • Victim reports being hit where there is pain. • Area is tender. • Shallow breathing Gently press inward on both sides of the chest at the same time to assess for a rib fracture.

Care for Rib Fractures• Help victim find a

comfortable position.• Stabilize the ribs with

a pillow or similar object.

• Give pain medication.• Seek medical care.

Flail Chest• Flail chest involves several ribs in the

same area broken in more than one place.

• Paradoxical movement is when the area over the injury moves in a direction opposite to that of the rest of the chest wall during breathing.

Recognizing Flail Chest• Paradoxical chest motion

takes place.• Breathing is very painful

and difficult.• Bruising may occur.

Care for Flail Chest• Support the chest.

• Apply hand pressure.• Place victim on injured side with blanket

underneath.• Monitor breathing.• Seek medical care.

Open Chest Injuries

An open chest injury is when the skin has been broken and the chest wall is penetrated.

Impaled Object in the Chest

An impaled object penetrates the chest wall. • Causes air and blood to escape into the space

between lungs and chest wall • Lung collapses.• Can lead to shock and death

Recognizing an Impaled Object in the Chest

• Usually easy to see • Object may be below skin surface.• Look for hidden objects.

Care for an Impaled Object in the Chest

• Stabilize the object in place with bulky dressings.

• Do not try to remove the object.

• Call 9-1-1.

Sucking Chest Wound

A sucking chest wound results when a chest wound allows air to pass into and out of the chest with each breath.

Recognizing a Sucking Chest Wound

• Blood bubbling out of chest wound during exhalation

• Sucking sound during inhalation

Care for a Sucking Chest Wound• Seal the wound.

• Plastic wrap or plastic bag• Tape plastic in place; leave one side open.• Drain to gravity.

• Lean or lay victim on injured side.• Remove plastic if victim has trouble

breathing or seems to be getting worse.• Call 9-1-1.

Abdominal Injuries• Abdominal injuries are either open

or closed and can involve hollow and/or solid organs.• Hollow organ rupture spills contents of

organ into abdomen.• Solid organ rupture results in internal

bleeding.

Closed Abdominal Injury• Closed abdominal injuries occur when

the internal abdominal tissues are damaged but the skin is unbroken.• Also known as blunt injuries

Recognizing a Closed Abdominal Injury

• Gently press all four quadrants of the abdomen.

• Notice:• Bruises or marks• Pain, tenderness,

muscle tightness, or rigidity

• Distention (swelling)

Care for a Closed Abdominal InjuryUnresponsive:• Place victim on left

side in comfortable position with legs bent (“fetal position”).

• Call 9-1-1.

Responsive:• Place victim on one

side in comfortable position with legs slightly bent.

• Call 9-1-1.

Open Abdominal Injury• Open abdominal injuries are those in

which the skin has been broken. • Also known as penetrating injuries

• Always serious • Usually cause internal organ damage

Care for a Penetrating Wound

• Stabilize the penetrating object.

• Place bulky dressings around object.

• Do not try to remove object. • Call 9-1-1.

Protruding Organs• Also called an evisceration• Severe injury in which internal

organs escape or protrude from wound

Care for Protruding Organs• Call 9-1-1.• Allow victim to stay

in comfortable position.• Legs pulled toward

abdomen• Cover protruding

organs.• Treat for shock.

Pelvic Injuries

Pelvic fractures are usually caused by falling or a motor vehicle crash.

Recognizing Pelvic Injuries• Pain in hip, groin, or back

• Increases with movement• Inability to stand or walk • Signs of shock• Check pelvis by gently pressing inward

and downward on tops of hips.

Care for Pelvic Injuries

• Treat the victim for shock.• Place padding between victim’s

thighs.• Tie victim’s knees and ankles

together.• Keep victim on a firm surface.• Call 9-1-1.