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Introduction to Chest Injuries

By

Thomas G. Weiser

, MD, MPH, Stanford University School of Medicine

Last full review/revision Jun 2020| Content last modified Jun 2020
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Chest injuries most often affect the ribs, upper part of the abdomen, lungs, blood vessels, heart, muscles, soft tissues, and breastbone. Sometimes the esophagus, collarbone, or shoulder blade is also injured.

In the United States, chest injuries cause about 25% of deaths due to severe injury. Many of the injuries that can cause death during the first minutes or hours after injury can be treated or stabilized in the emergency department without the need for major surgery.

Causes of Chest Injuries

The chest can be injured by blunt force (such as in motor vehicle crashes, falls, or sports injuries) or by an object that penetrates it (such as a bullet or knife).

Chest injuries are often serious or immediately life threatening because they interfere with breathing or circulation. Some injuries damage the ribs and chest muscles (called the chest wall) severely enough to make it difficult for the lungs to inflate normally. Damage to the lungs themselves interferes with gas exchange Exchanging Oxygen and Carbon Dioxide The primary function of the respiratory system is to take in oxygen and eliminate carbon dioxide. Inhaled oxygen enters the lungs and reaches the alveoli. The layers of cells lining the alveoli... read more , the main function of the lungs in which oxygen is acquired and carbon dioxide is expelled. Chest injuries can cause circulatory problems if they result in a lot of bleeding. Bleeding is often inside the chest wall, which also interferes with breathing. Also, injury to the heart can affect circulation by interfering with the heart's ability to pump blood to the body.

Chest injuries that are common or can be severe include the following:

Did You Know...

  • Simple treatments, such as insertion of needles or tubes to treat certain chest injuries, can be lifesaving.

Symptoms of Chest Injuries

The injured area is usually tender or painful. Pain is worse when people inhale. The chest may be bruised. Sometimes people are short of breath. If the injury is severe, they may feel very short of breath, drowsy, or confused, and the skin may be cold, sweaty, or blue. Such symptoms may develop when the lungs malfunction severely (respiratory failure Respiratory Failure Respiratory failure is a condition in which the level of oxygen in the blood becomes dangerously low or the level of carbon dioxide in the blood becomes dangerously high. Conditions that block... read more ) or people are in shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more . People in shock typically have dangerously low blood pressure and feel as if their heart is racing.

Other symptoms depend on the specific chest injury. For example, sometimes air accumulates under the skin in people with pneumothorax. Affected skin feels crackly and makes a crackling sound when touched. The veins in the neck are sometimes enlarged if blood or fluid accumulates in the sac around the heart and interferes with the heart's ability to pump blood (called cardiac tamponade Cardiac Tamponade Cardiac tamponade is pressure on the heart by blood or fluid that accumulates in the two-layered sac around the heart (pericardium). This disorder interferes with the heart's ability to pump... read more ) or if tension pneumothorax Tension Pneumothorax Tension pneumothorax occurs when air accumulates between the chest wall and the lung and increases pressure in the chest, reducing the amount of blood returned to the heart. Symptoms include... read more develops.

Diagnosis of Chest Injuries

  • A doctor's evaluation

  • Imaging

Usually, a chest injury is obvious. However, the severity of chest injuries cannot be determined without a doctor's evaluation.

First, doctors use a stethoscope to determine whether all parts of the lungs are receiving air, and they carefully examine the neck and chest for injuries. When people are having difficulty breathing, doctors place a sensor on the person's finger (pulse oximeter) to measure the amount of oxygen in the blood. Sometimes doctors measure the amount of oxygen and carbon dioxide in the blood with a blood test (arterial blood gas measurement).

A chest x-ray X-Rays of the Chest Anyone thought to have a heart disorder has chest x-rays taken from the front and the side. Typically, the person is standing upright, but chest x-rays can be done with people lying in bed if... read more X-Rays of the Chest is almost always taken. Chest x-ray shows most cases of pneumothorax Traumatic Pneumothorax Traumatic pneumothorax occurs when air accumulates between the chest wall and the lung because of an injury. It causes the lung to collapse partially or completely. People have chest pain and... read more , hemothorax Hemothorax Hemothorax is an accumulation of blood between the lung and the chest wall. People may feel light-headed and short of breath and have chest pain, and the skin may be cool, sweaty, or bluish... read more , and collarbone fractures Collarbone Fractures Fracture of the collarbone (clavicle) is a break in the long bone that runs horizontally from the top of the breastbone (sternum) to the top of the shoulder blade (scapula). Collarbone fractures... read more , as well as some rib fractures Rib Fractures A rib fracture is a crack or break in the bones enclosing the chest. Rib fractures cause severe pain, particularly when a person breathes deeply. A chest x-ray is usually taken. People are given... read more Rib Fractures . However, ultrasonography is usually needed to show heart injuries Blunt Injury to the Heart Blunt injury to the heart is a blow to the chest that bruises the heart muscle, tears (ruptures) the heart's walls, or damages a heart valve. People may feel that their heart is pounding or... read more . Computed tomography (CT), ultrasonography, and/or aortography (angiography of the aorta) Overview of Imaging Tests Imaging tests provide a picture of the body’s interior—of the whole body or part of it. Imaging helps doctors diagnose a disorder, determine how severe the disorder is, and monitor people after... read more may be done if doctors suspect injury to the aorta.

Treatment of Chest Injuries

  • Support of breathing and circulation

  • Treatment of the specific injury

Injuries that are immediately life threatening are treated as quickly as possible. The specific treatment depends on the injury.

For all injuries, doctors take measures to support breathing and circulation if necessary. People may be given oxygen (for example, by nasal prongs, by face mask, or through a breathing tube) and intravenous fluids or sometimes blood transfusions. People with severe chest injuries are admitted to the hospital.

People may be given pain relievers (analgesics) to lessen pain.

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Fractures of the Jaw and Midface
Fractures to one or more facial structures can result from a single injury. Jaw fractures may occur to the mandible, or lower jaw, or to the maxilla, bone of the upper jaw. Other structures susceptible to fracture include the eye sockets, nose, and cheek bones. Which of the following facial structures is most likely to fracture if a person falls from a great height or hits the windshield of a car face-first during a motor vehicle accident?
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