Assessment

Look, Listen and Feel for:

• Increased work of breathing
• Abnormal chest wall  movement
• Tracheal shift
• Sucking chest wound
• Cyanosis 
• Abrasion or bruising
• Look for circumferential burns to chest or abdomen
• Absent / Decreased breath sounds
• Dull sounds or hyper-resonance on percussion
• Crepitus
  

Management

• Give oxygen

   Nasal prongs                         

Simple oxygen facemask      

  Non rebreather oxygen facemask     

• Do needle decompression with oxygen administration and IV fluids for a tension pneumothorax

• Apply Three-sided dressing for sucking chest wound

• Assist breathing with bag-valve-mask ventilation if patient breathing slower than normal with poor oxygen saturation

Examples of Conditions: 

1. Tension Pneumothorax

Signs

• Hypotension with;
• Difficulty in breathing
• Absent  breath sounds on the affected side
• Hyper-resonance on percussion on the affected side
• Distended neck veins
• May have tracheal shift away from affected side

Management: As indicated above

2. Sucking Chest Wound

Signs:

• Abnormal passageway of air on the chest wall created as a result of traumatic injury
• Difficult in breathing
• Chest pain

Management: As indicated above

insert image of 3-sided dressing

3. Flail Chest

Signs:

• Difficulty in breathing
• Chest pain
• Chest wall moving in the opposite direction of the rest of the chest when breathing

Management: Oxygen, pain management and BVM if rate not adequate

4. Haemothorax

Signs and symptoms 

• Difficulty in breathing
• Decreased breath sounds on affected side
• Dull sounds on percussion on affected side
• May be in shock

Management: oxygen, IV fluids, early transfer for chest tube insertion