Chest injuries

Fracture of the ribs
This is a common fracture which is usually caused by falling against a hard surface or by a crushing injury. Signs and symptoms are:
- sharp, continuous pain which is increased when breathing in or by coughing;
- shallow breathing to prevent chest movements;
- marked localised tenderness when the injured area is felt gently.
 
Uncomplicated rib fracture:
- make the casualty sit down in the normal sitting position but, if pain is severe, place him in the half-sitting-up position, leaning over towards the injured side;
- transport him in this position to the ship’s hospital or his cabin;
- treat pain;
- do not put strapping around his chest;
- keep him at rest in the position he finds most comfortable, either in bed or sitting in a chair or on the floor.
 
Severe chest injuries
 
The ribs form a rigid cage which protects the heart and lungs. Severe force may cause any one or a combination of the following injuries:
- a superficial wound and/or bruising of the chest
- a penetrating (sucking) wound of the chest wall
- multiple rib fractures on one or both sides of the chest, together with injury to the underlying lung and its covering (the pleura);
- a ‘stove-in’ segment of the chest wall.
 
The fragments of a fractured rib are usually held in place by the muscles between the ribs. After severe injury, a rib fragment may be driven inwards, causing a tear in the covering of the lung with consequent leaking of blood or air into the chest cavity. The lung on that side will then collapse and/or be compressed, resulting in difficulty in breathing. There may be a blue/grey tinge to the skin of the face and lips, and the casualty may cough up frothy blood-stained sputum.