EMS Trauma Emergencies - Thoracic Injuries

The "Deadly Dozen" is a term used in emergency medicine and prehospital care to refer to a list of twelve potentially life-threatening chest injuries. 

EMS Providers need to be familiar with these injuries because prompt recognition and appropriate management are crucial for the survival and well-being of the patient. 

Here are the Deadly Dozen Chest Injuries and why they are important for EMS providers to know about:

1. Lung Contusion: A lung contusion is a bruising of lung tissue caused by chest trauma, leading to impaired gas exchange and respiratory distress. Monitoring for signs of respiratory compromise is crucial.

2. Tracheobronchial Injury: Trauma to the trachea or bronchi can lead to airway compromise and respiratory distress. EMS providers should maintain a high index of suspicion for this injury in patients with chest trauma.

3. Diaphragmatic Injury: A diaphragmatic injury can lead to herniation of abdominal contents into the chest, causing respiratory compromise and other complications. EMS providers should be aware of the potential signs and manage accordingly.

4. Esophageal Injury: Trauma to the chest can cause damage to the esophagus, leading to leakage of gastric contents into the chest cavity. EMS providers should be vigilant for signs of mediastinitis and infection.

5. Open Pneumothorax (Sucking Chest Wound): An open wound in the chest allows air to enter the pleural space, leading to a pneumothorax. It can impair ventilation and lead to respiratory distress. EMS providers must apply airtight seals to manage it.

6. Tension Pneumothorax: This occurs when air accumulates in the pleural space and compresses the lung, causing pressure on the heart and other vital structures. It can lead to cardiovascular collapse and requires immediate intervention, such as needle decompression.

7. Massive Hemothorax: This injury involves the accumulation of blood in the pleural space, which can impair lung function and cause hypovolemic shock. It may result from chest trauma, and EMS providers need to identify and manage it.

8. Flail Chest: A flail chest occurs when a segment of the ribcage becomes detached due to multiple rib fractures. It can impair ventilation and lead to respiratory failure. Stabilization and pain management are essential.

9. Cardiac Tamponade: This is a condition where blood or fluid accumulates in the pericardial sac, compressing the heart and impairing its function. It can cause hemodynamic instability and requires immediate intervention.

10. Aortic Disruption: Trauma can cause a tear or rupture in the aorta, which can lead to massive internal bleeding and shock. Early recognition and rapid transport are essential.

11. Myocardial Contusion: Blunt chest trauma can lead to a bruising or injury to the heart muscle, causing arrhythmias, myocardial infarction, or heart failure. EMS providers need to monitor for signs of cardiac injury.

12. Pulmonary Contusion: Similar to lung contusion, pulmonary contusion involves bruising of lung tissue, which can lead to impaired gas exchange and respiratory distress. EMS providers should monitor for signs of respiratory compromise.

EMS providers need to be aware of these chest injuries and their potential consequences because early recognition and appropriate management can be life-saving. 

Proper assessment, stabilization, and rapid transport to a medical facility for definitive care are critical in the prehospital setting for patients with these injuries.