TL;DR
Chest Injuries: Rib fractures, flail chest, pneumothorax, hemothorax, open pneumothorax, cardiac tamponade.
Chest Injuries
Definition
Rib fractures, flail chest, pneumothorax, hemothorax, open pneumothorax, cardiac tamponade.
Related Procedures
Procedures related to chest injuries in the EMS setting:
- Stroke recognition: Cincinnati Prehospital Stroke Scale (facial droop, arm drift, speech) then last known well time then transport to stroke center
- Spinal motion restriction: mechanism + neuro deficit or midline tenderness = full SMR with C-collar and long board
- Pediatric weight-based dosing: Broselow tape for length-based weight estimation in emergencies
Common Errors
Critical errors in prehospital application of chest injuries:
- Failing to reassess after intervention. Vital signs must be rechecked every 5 minutes for unstable patients
- Incorrect medication dosing. Always use length-based estimation (Broselow tape) for pediatric patients
- Tunnel vision on one finding while missing the complete clinical picture
- Not communicating changes to receiving facility during transport
Differential Diagnosis
When assessing chest injuries, use structured assessment tools to differentiate between possible causes:
Glasgow Coma Scale: Components: Eye opening (1-4), Verbal response (1-5), Motor response (1-6). Scoring: 3-15, 8 or less = severe, 9-12 = moderate, 13-15 = mild.
APGAR: Components: Appearance, Pulse, Grimace, Activity, Respiration. Scoring: 0-10 at 1 and 5 minutes, under 7 needs intervention.
Practical Example
Field Scenario: An 8-month-old infant is found unresponsive. Parents report fever of 104 F for 2 days. Fontanelle is bulging. Suspect meningitis: manage airway, IV access, rapid transport.
This scenario tests your ability to apply knowledge of chest injuries under time pressure with incomplete information, exactly the type of decision-making the certification exam assesses.
Regulatory Context
Regulatory context for chest injuries includes federal and state requirements. Healthcare facilities must comply with CMS Conditions of Participation, state licensure requirements, and accreditation standards (Joint Commission or AAAHC). Non-compliance can result in citations, fines, or loss of Medicare/Medicaid reimbursement.
Key Values & Ranges
Key values and ranges relevant to chest injuries in prehospital care:
| Parameter | Adult | Pediatric |
|---|---|---|
| SpO2 | 95-100% | 95-100% |
| ETCO2 | 35-45 mmHg | 35-45 mmHg |
| GCS | 15 is normal, under 8 = severe TBI | modified pediatric GCS for preverbal |
| respiratory rate | 12-20 breaths/min | 25-50 (infant), 15-30 (child) |
| heart rate | 60-100 bpm | 80-150 bpm (infant), 70-120 bpm (child) |
| temperature | 97.8-99.1 F (36.5-37.3 C) | same range, rectal preferred under 2yo |
Why It Matters
Chest injury recognition and management tested on EMT and Paramedic exams.
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