Potentially Life-Threatening Injuries

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

Simple Pneumothorax

• Air leak into the pleural cavity, but there is no one way valve and so 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

• Blood in the thoracic cavity pleural space
• Usually in association with a chest wall injury
• Reduced air entry and stoney 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 as bruising of the lung tissue
• Not immediately apparent and a high index of suspicion is important based on the mechanism of injury
• Care should be taken with fluid resuscitation and  guidelines used for fluid resuscitation should be stringently applied
• 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, laryngeal tenderness, hoarseness or 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 the ligamentum arteriosum, as the aorta is relatively fixed here compared to the rest of the relatively mobile aorta
• ABCDE
• Oxygen
• Transfer to an Emergency Department as soon as possible

Pictorial representation of aortic rupture

Traumatic Diaphragmatic Rupture

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

Mediastinal Traversing Wounds

• These can be rapidly fatal and can cause a number 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