Premergency First Aid, CPR and AED Manual

8 Muscle, Bone and Joint Injuries

First Aid for Rib(s) Injury • Expose and assess any area of D.O.T.S. • Assess any wounds for penetration of the chest wall. Dress any wounds. Occlude (seal) any open chest wounds (See Chapter 7, Bleeding andWound Care). • If injury permits, position the patient to make breathing easier. This may be seated and leaning forward slightly or laying down. • Sling the injured arm to transfer weight to the uninjured side. This helps reduce pain and difficulty breathing. • Light supportive pressure over the injured rib may make breathing less painful. The patient can use their free hand on the uninjured side for this. • Give ongoing care until medical help takes over.

Although painful, unless complicated, a fractured breastbone or ribs does not usually cause inadequate breathing or shock. Flail Chest When a rib is broken at two or more points, it causes that section to lose continuity with the rigid chest wall. A flail section is an area that moves opposite to the way it should. For example, when the patient inhales and their chest expands, the flail section collapses, causing a depressed area over the injury. When the patient exhales and the chest wall contracts, the flail section pushes out, causing a bulge over the injury. This is called paradoxical movement. Typically three or more adjacent ribs, each with two fractures, are required to cause a flail chest.

313

www.preohs.com