g. Paradoxical breathing. Paradoxical breathing, an indication of a flail chest, occurs when part of the chest moves in when the casualty inhales and out when the casualty exhales--the opposite of normal motion. h. Coughing up blood (hemoptysis) or bloody sputum. i. Enlarged neck veins. j. Bulging tissue between the ribs or above the clavicles (collarbones). This sign is an indication of tension pneumothorax or hemothorax. k. Tracheal deviation (a shift of the trachea from its normal midline toward the unaffected side of the casualty's body). The shift is caused by the buildup of pressure on the injured side due to tension pneumothorax. Tracheal deviation is a very late sign. l. Mediastinal shift (movement of the mediastinum--heart, great blood vessels, trachea, and esophagus--from its normal position toward the unaffected side of the body). Mediastinal shift is caused by the buildup of pressure due to tension pneumothorax or hemothorax. CAUTION:
Mediastinal shift indicates a life-threatening condition (compression of the heart and blood vessels). The pressure must be relieved as soon as possible by trained medical personnel.
3-15. CHECK FOR A FRACTURED RIB A simple fracture of a rib is usually caused by a direct blow to the chest or by compression of the chest. The casualty usually has local pain at the site of the fracture and the pain is usually aggravated when he breathes or moves. There may be a bruise or swelling at the fracture site. The most common fracture sites are the fifth to the tenth pair of ribs. The upper pairs of ribs are protected by the bones of the shoulders. The lower (eleventh and twelfth) pairs of ribs are not attached to the sternum and have greater flexibility. 3-16. TREAT A CASUALTY WITH A FRACTURED RIB a. Immobilize the Fracture. Make the casualty comfortable and keep him as still as possible. Apply a sling and swathe to the arm on the injured side (figure 3-9). The sling and swathe help to immobilize the injured side as much as possible. There is a danger the rib may be broken in two places. If so, a rib segment is free of the sternum and spine and the segment may "float." The sharp end of the rib segment could puncture the lung or damage the heart or major blood vessels. Subcourse MD0533, Treating Fractures in the Field, describes the procedures for applying slings and swathes.
MD0554
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