# First Aid/Chest & Abdominal Injuries

Injuries to the chest and abdomen can be difficult to recognize and treat, and many injuries can go unnoticed until they become very serious. The muscle and bones that serve to protect vital organs can also mask their injuries – or at worst contribute to them. It is important for the rescuer to consider injuries that lie beneath the skin.
In addition, the different organs react in different ways when subjected to trauma. Hollow organs (such as the bladder) tend to rupture, releasing their contents into the surrounding space. Solid organs (such as the liver) tend to tear instead, often bleeding at a slow enough rate to be overlooked.

## Closed Chest Injuries

Closed Chest injuries can be inherently serious, as this area of the body houses many critical organs, such as the heart, lungs, and many blood vessels. Most chest trauma injuries should receive professional medical attention. Always call for an ambulance for any potentially serious chest injury.

### Rib Injuries

A common result of trauma to the chest is damage to the victim's rib cage. The curved shape of the rib cage helps to deflect the force of some injuries, but damage to cartilage or the ribs themselves can still result. While a single broken rib can be very painful for the patient, a number of broken ribs can lead to other complications. A victim with broken ribs may take very shallow breaths without even noticing it, as their body tries to prevent the pain with taking a full breath.
When many adjoining ribs are broken in different places, a portion of the rib cage can move in the opposite direction the chest should. This is known as a "flail" segment, and can make breathing very painful and less effective.

### Recognition

* Trouble breathing
* Shallow breathing
* Tenderness at site of injury
* Deformity & bruising of chest
* Pain upon movement/deep breathing/coughing
* Dusky or blue lips or nail beds
* May cough up blood
* Crackling feeling upon touching victim's skin (sounds and feels like "Rice Crispies")

### Treatment

* Assess ABCs and intervene as necessary
* Call for an ambulance
* Assist the victim into a position of comfort (typically seated upright, to avoid fighting gravity)
* Conduct a secondary survey
* Monitor patient's condition carefully
* Be vigilant, keep alert for any changes
* If a flail segment is suspected, tightly secure a bulky dressing (such as a tightly folded hand towel) to help stabilize the injury

## Open Chest Wounds

An open pneumothorax or sucking chest wound – the chest wall has been penetrated (by knife, bullet, falling onto a sharp object...)

### Recognition

* An open chest wound – escaping air
* Entrance and possible exit wound (exit wounds are more severe)
* Trouble breathing
* Sucking sound as air passes through opening in chest wall
* Blood or blood-stained bubbles may be expelled with each exhalation
* Coughing up blood

### Treatment

* Assess ABCs and intervene as necessary
* Do not remove any embedded objects
* Call for an ambulance
* Flutter valve over wound, as described below
* Lateral positioning: victim's injured side down
* Treat for shock
* Conduct a secondary survey
* Monitor vitals carefully

#### Making a flutter valve

Get some sort of plastic that is bigger than the wound. Ideas: credit card or similar, Ziploc bag, some first aid kits will have a ready-to-use valve. Tape the plastic patch over the wound on only 3 sides. The 4th side is left open, allowing blood to drain and air to escape. This opening should be at the bottom (as determined by the victim’s position). When the casualty inhales, the bag will be sucked in, but when the casualty exhales, the air will exit through the untaped side.

## Abdominal Injuries
### Protruding organs

If a trauma injury has caused the victim's internal organs to protrude outside the abdominal wall, do not push them back in. Doing so will only cause greater complications - remember that preventing further injury is one of the aims of first aid.
Instead, have the person lie flat with their knees bent and cover the organs with a moist, sterile dressing composed of material that will not stick to the affected organs. Normally a special dressing, ABD Pad (Army Battle Dressing) or trauma dressing is used, though large Telfa dressing will work well. Gauze can stick if it is dry – be careful to keep normal gauze moist if you do use it. Paper products like paper towel or toilet paper must never be used, as they will turn to pulp, causing major complications. Do not allow the victim to eat or drink, though they may complain of extreme hunger or thirst. Call an ambulance, treat for shock, and monitor ABCs until the emergency medical team arrives.

### Internal Bleeding

If the abdominal injury does not cause an open wound, have the person lie flat with their knees bent and treat for shock until EMS arrives.