Potentially Life Threatening Injuries

These injuries still require serious consideration, in a player sustaining serious chest trauma.

Simple Pneumothorax

  • Air leak into pleural cavity, but there is no one way valve and hence this does not “tension”
  • Reduced air entry and hyper-resonant percussion note on affected side.
  • Differs from tension pneumothorax in the clinical state of the patient. Those with a simple pneumothorax may be in pain and short of breath, but do not present with the profound distress and compromise of those with a tension pneumothorax
  • ABCDE
  • Oxygen
  • Transfer to the Emergency Department as soon as possible

Pictorial representation of a simple pneumothorax

Haemothorax

  • Bleed into the thoracic cavity.
  • Usually in association with a chest wall injury
  • Reduced air entry and stony dull percussion note on the affected side.
  • Not as compromised, either respiratory or haemodynamically, as a massive haemothorax
  • ABCDE
  • Oxygen
  • Transfer to the Emergency Department as soon as possible

Pictorial representation of a haemothorax

Pulmonary Contusion

  • Complex process of lung injury which in simple terms can be considered akin to bruising of the lung tissue
  • Not immediately apparent and a high index of suspicion is important based on the mechanism of injury
  • ABCDE
  • Oxygen
  • Transfer to the Emergency Department as soon as possible

Tracheal Injury

  • It is easy to overlook this injury during the initial assessment, particularly if there is no airway compromise
  • It may present as subcutaneous emphysema across the anterior neck, haemoptysis, larnygeal tenderness, hoarseness or simply pain in the anterior neck region
  • ABCDE
  • Oxygen
  • Transfer to the Emergency Department as soon as possible

Traumatic Aortic Rupture

  • Due to rapid acceleration or deceleration injury.
  • Rupture usually occurs at ligamentum arteriosum, since the aorta is relatively fixed here when compared to the rest of the relatively mobile aorta
  • ABCDE
  • Oxygen
  • Transfer to the Emergency Department as soon as possible

Pictorial representation of aortic rupture

Traumatic Diaphragmatic Rupture

  • Most diagnosed on left since the liver confers some protection on the right.
  • May hear bowel sounds in the chest
  • ABCDE
  • Oxygen
  • Transfer to the Emergency Department as soon as possible

Mediastinal Traversing Wounds

  • These can be rapidly fatal, and can cause a plethora of serious thoracic injuries. These can be identified as already outlined in this chapter.
  • ABCDE
  • Oxygen
  • Specific treatment for identified injuries.
  • Transfer to the Emergency Department as soon as possible