CHEST INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 122

Figure 9-7. Subject lying on a rolled-up garment to support a flail chest
Oxygenshouldbeadministered, andtheindividual shouldbeevacuated immediately.A
large area of flail, particularly at high altitudes, may be fatal.
PENETRATING CHEST INJURIES
Afallontoapointedobject suchasaniceaxorskipolemaypunchaholeinthechestwall
and then into the lung. If the opening in the chest is small and seals quickly but leaves a
hole in the lung, air may leak into the pleural cavity, causing a pneumothorax. The air leak
may cause a tension pneumothorax ( Fig. 9-8 ).
If the defect in the chest wall is large and air is sucked in and out of the chest cavity
with every breath, the injury is obvious ( Fig. 9-9 ). The opening should be sealed as fast
as possible with a pad of sterile dressings, preferably with an inner layer of gauze impreg-
nated with petroleum jelly—or a clean cloth if that is all that is available. The pad should
be taped securely over the open wound, but an edge that can be lifted to allow air to escape
should be available in case a tension pneumothorax develops.
Supplemental oxygen should be given immediately. Decompression of the chest with
a chest tube may be necessary. Shock almost invariably accompanies a large penetrating
wound of the chest and should be anticipated. If the person is not allergic to penicillin, a
penicillinase-resistant penicillin or a cephalosporin should be given every six hours until
evacuation is completed.
All individuals with penetrating injuries of the chest must be evacuated at the earliest
possible moment because serious underlying injury may be present and the potential for
severe functional impairment of respiration is great.
Figure 9-8. Pulmonary function with a punctured chest wall 4