Chest Trauma

A car accident can result in myriad injuries to any area of the body. One of the areas most susceptible to injury is the chest area, due to its location directly behind the steering wheel. Chest trauma can result from either shearing, blast, or compressive forces, or a combination thereof. A car accident would most likely entail both shearing and compressive forces.

What is Chest Trauma?

Chest trauma causes many fatalities in the United States each year. In fact, over 16,000 deaths occur as a result of chest trauma every year. Chest trauma can affect the skeletal bones such as ribs, sternum, clavicle, and scapula, the lungs and trachea, the heart, the esophagus, and the large blood vessels of the chest.

There are two different types of chest trauma: blunt force trauma, and penetrating trauma.

Blunt Force Chest Trauma

Blunt force chest trauma describes injuries wherein the blood flow or oxygen flow (or both) are diminished. Often, severe pain is present that makes taking a full breath impossible. The organs, tissues, and muscles of the chest can be bruised, swollen, and bleeding. If any of the large vessels supplying blood to the heart are damaged, severe blood loss and death can occur within minutes.

Penetrating Chest Trauma

Penetrating chest trauma injuries are described in three levels: low, medium, or high velocity. These levels of velocity describe the force with which the object penetrated the chest, and are measured by how much damage has occurred to the wounded area and surrounding anatomy.

Low velocity penetrating traumas are usually knife wounds wherein the only area of damage is found where the knife contacts and penetrates the chest. Medium velocity penetrating traumas would include handgun or air-powered pellet gun injuries where a moderate amount of tissue destruction occurs outside the area of impact. A high velocity penetrating trauma is caused by objects such as military weapons, rifles, and shotguns. In a high velocity trauma, there is extensive damage to tissues outside the area of impact.

Symptoms of Chest Trauma

By and large, the symptoms of the different velocities of chest trauma present much the same whether they were blunt force trauma or penetrating trauma. These symptoms include:

  • Difficulty taking a full breath due to pain or bleeding;
  • Hypotension (low blood pressure) caused by severe blood loss;
  • Nausea, pale and clammy skin, or extreme thirst caused by severe blood loss;
  • Incomplete lung expansion during breathing;
  • Sepsis due to tears in the esophagus that may result in leakage of food into the bloodstream;
  • Chest wall hematoma;
  • Coughing up blood;
  • Flail chest (a condition seen when the chest is visibly “sucked in” during breathing);
  • Puncture wounds to the chest where you can audibly hear the sound of the intake of air.

Causes of Chest Trauma

Chest trauma can be caused by a wide variety of accidents – most of them involving extreme forces. Here are just a few ways that chest trauma can occur:

  • Automobile accidents and crashes
  • Motorcycle accidents
  • Boating accidents
  • ATV accidents
  • Falls from significant height
  • Horseback-riding injuries
  • Sports injuries
  • Gunshot wounds
  • Knife wounds
  • Combat injuries
  • Blast injuries

Diagnosis of Chest Trauma Injuries

Physical examination is one of the best ways to diagnose chest trauma. If the patient is lucid and responsive, the physician will ask questions regarding location and severity of pain. Multiple X-rays will be ordered to help the medical team assess the traumatic injuries that have occured. X-rays will show rib fractures, or breaks in the sternum, clavicle, or scapula bones, and will also show a partially or fully collapsed lung. An x-ray will help identify any foreign object that are in the chest cavity, such as bullets or shrapnel.

Often, a doctor will order a contrast dye to be injected into the circulatory system so that the arteries and veins can be viewed via x-ray. This helps show any damage to the heart and major blood vessels and can confirm internal bleeding into the chest. An MRI may be ordered to diagnose soft tissue injuries.

Treatment of Chest Injuries

Because of the risk of severe bleeding, cardiac arrest, and other potentially fatal issues, treatment of a traumatic chest injury begins at the scene of the accident. Emergency medical personnel are well-trained in what to do in the event of a chest injury to keep a patient stable enough to make it to a hospital emergency room or trauma center. Immediate medical transport is imperative to get the patient to an emergency room for diagnosis and life-saving treatment as soon as possible.

In the emergency room, any rib fractures will be treated immediately as broken ribs can lead to blood vessel damage and punctured lungs, both potentially fatal symptoms of chest trauma. A broken rib can make taking a deep breath very painful, but shallow breathing can lead to pneumonia, so the doctor may recommend anesthesia for the nerves that supply the lungs. This makes breathing much easier and lessens the chance that pneumonia will develop. The doctor may also recommend breathing treatments to make sure the lungs are expanding fully.

If there has been a sudden blunt trauma to the chest, as is often seen in high-speed collision accidents and falls from significant height, there will be a sudden increase in chest pressure. The blood will not move through the heart properly, and the patient may develop cyanosis, a blue coloring to the skin caused by poor circulation. If this happens, the head portion of the patient’s bed will be elevated to reduce pressure to the head, and oxygen will be given until surgery can be performed to fix the damaged heart muscles.

If a pulmonary contusion has occurred, lung oxygen exchange is blocked due to damaged lung tissue and blood-filled alveoli. This will normally right itself with time, as the body circulates the blood out of the alveoli naturally.

In the event of a pericardial tamponade, blood fills the chest area and will prevent the heart from expanding normally as it pumps. Blood pressure drops. A needle will be inserted into the chest cavity to draw out the excess blood and relieve the pressure on the heart so that it can fully expand and contract, and maintain proper circulation.

These are but a few of the many chest traumas that can occur due to an accident. If you’ve suffered chest trauma due to an accident caused by someone else’s negligence, and need an educated opinion regarding your legal options and the strength of your case, we at Sevey, Donahue & Talcott encourage you to come in for a free, confidential consultation. We can be reached by phone at (916) 788-7100 or through our website.