How to Recognize, Treat & Monitor Chest Injuries

A chest injury is any form of physical injury to the chest including the ribs, heart and lungs.

One of the best ways to identify a chest injury is by the mechanism of injury. Typically chest injuries are caused by blunt mechanisms such as motor vehicle collisions or penetrating mechanisms such as stabbings or gunshots.

If you’ve been hit hard enough in the chest to make you think you may have broken a rib or two, always seek medical advice.


Broken Rib

How to Recognize:

  • Extreme pain when taking a breath
  • Tenderness to the chest or back over an area of ribs
  • A “crunchy” feeling under the skin – Crepitus
  • Severe shortness of breath

How to Treat:

It will heal on its own and probably not develop any additional problems. The bad news is it hurts a lot and there is really very little you can do for it.


Penetrating (sucking) chest wound

How to Recognize:

  • It can be difficult to identify when a penetrating wound is sucking air or not. They don’t always make noise. Assume any penetrating wound to the chest is a sucking chest wound.
  • A sucking chest wound is a hole in the chest. When the chest cavity is expanded in order to inhale, air not only goes into the mouth and nose like normal, it also goes into the hole.
  • Sucking chest wounds are dangerous because they lead to pneumothorax (collapsed lungs)

How to Treat:

  • Seal the sucking chest wound.
  • Put something plastic (preferably sterile) over the hole and tape it down on all sides. Sit the conscious casualty down leaning towards the injured side.
  • Unconscious casualties should be put into the recovery position and rolled onto the injury.
  • This injury requires emergency medical treatment.

Flail Chest

How to Recognize:

  • One or more broken ribs that are broken in more than one place.
  • Instead of rigidly holding the normal shape of the chest, flail chest results in a segment of the chest wall flailing back and forth in the opposite direction of the rest of the chest wall – this is called paradoxical breathing.
  • If not treated promptly, flail chest can lead to complications.

How to Treat:

  • Stabilize the flail chest.
  • Use a hard pad to put pressure on the flail segment. Holding the flail segment in place keeps it from moving in an opposite direction as the surrounding muscle and bone. Sit the conscious casualty down leaning towards the injured side. Unconscious casualties should be put into the recovery position and rolled onto the injury.
  • This injury requires emergency medical treatment.

Monitoring Chest Injuries

Recognising internal chest injuries is difficult and the most important step is getting professional emergency medical help. Careful observation is important. Signs to look for include:

  1. Severe shortness of breath
  2. Unequal chest (one side looks bigger than the other)
  3. Tracheal movement to the uninjured lung
  4. Veins on the neck bulging
  5. Blue lips and neck (lack of oxygen)
  6. No lung sounds on one side