There are two major categories of chest wounds, blunt and penetrating, but there are a number of injuries to specific structures and organs within the chest. Chest wounds can range from a minor bruising of the chest wall to fatal injuries of the heart or great vessels.
Blunt Vs. Penetrating
Blunt chest injuries are the result of motor vehicle collisions, falls or interpersonal violence. According to "Clinical Practice of Emergency Medicine", blunt chest injuries account for about 25 percent of all trauma-related deaths in the United States (Reference 1). Penetrating injuries to the chest occur from gunshot, stabbings and mechanical accidents or implements. Penetrating wounds also are often the result of interpersonal violence.
Chest Wall Injuries
Injuries to the chest wall include contusions and rib fractures. A contusion, or bruising of the chest wall is a common injury from blunt trauma that will cause pain for the patient. Pain with contusions typically increases during deep breathing or coughing. Fractured ribs are also common injuries to the chest and occur more frequently in adults than in children because the adults ribs have less elasticity (Referemce 1).
Flail Chest
According to "Emergency Nursing Core Curriculum", a flail chest wound occurs when two or more adjacent ribs are fractured in two or more locations (Reference 2). This causes a free floating segment of ribs. Depending on the size of the flail segment, patients may need a tube placed through the mouth into the trachea that is connected to a mechanical breathing machine to assist with their breathing.
Pneumothorax
Penetrating or blunt wounds can cause a loss of the negative pressure in the chest cavity called a pneumothorax. When this occurs it can cause a partial or total collapse of the lung on the affected side. If air becomes trapped in the chest and cannot escape, it can rapidly become fatal because the trapped air will collapse a lung and compress the heart and the aorta. When air is trapped, it is called a tension pneumothorax.
Heart and Great Vessels
As noted in "Clinical Practice of Emergency Medicine", by virtue of its location in the chest, the heart is susceptible to injury when there is chest trauma (Reference 1). The aorta is the largest artery in the body and is protected in the chest cavity. When there is injury to the chest, there is potential that the aorta can be torn or ruptured from penetration. Injury to the aorta can cause sudden death.
References
- "Clinical Practice of Emergency Medicine"; Lippincott Williams & Wilkins; 2010
- "Emergency Nursing Core Curriculum"; Saunders Elsevier; 2007
