| |
The second priority is the establishment of
adequate ventilation.
| 1 |
Inspect
(LOOK)
Inspection of respiratory rate is essential. Are any of the following present?
| • |
Cyanosis |
| • |
Penetrating
injury |
| • |
Presence
of flail chest |
| • |
Sucking
chest wounds |
| • |
Use
of accessory muscles. |
|
| 2 |
Palpate
(FEEL)
Palpate for:
| • |
Tracheal
shift |
| • |
Broken
ribs |
| • |
Subcutaneous
emphysema. |
Percussion
is useful for diagnosis of haemothorax and pneumothorax.
|
| 3 |
Auscultate
(LISTEN)
Auscultate for:
| • |
Pneumothorax
(decreased breath sounds on site of injury) |
| • |
Detection
of abnormal sounds in the chest. |
|
| 4 |
Resuscitation
action
| • |
Insert
an intercostal drainage tube as a matter of priority,
and before chest X-ray if respiratory distress
exists, to drain the chest pleura of air and blood |
| • |
When
indications for intubation exist but the trachea
cannot be intubated, consider using a laryngeal
mask airway or direct access via a cricothyroidotomy. |
|
SPECIAL NOTES
| 1 |
If
available, maintain the patient on oxygen until complete
stabilization is achieved
|
| 2 |
If
a you suspect a tension pneumothorax, introduce a large-bore
needle into the pleural cavity through the second intercostal
space, mid clavicular line, to decompress the tension
and allow time for the placement of an intercostal tube
|
| 3 |
If
intubation in one or two attempts is not possible, a
cricothyroidotomy should be considered a priority. This
depends on experienced medical personnel being available,
with appropriate equipment, and may not be possible in
many places.
Do not persist with intubation attempts without ventilating the patient.
|
|
|
|
