Chest Injuries

Chest trauma caused by seat-belt tension or blunt-force trauma can be extremely painful and occasionally life threatening. The bones of the chest include the sternum (or breastbone) and the ribs, which articulate from the sternum and surround the organs of the chest. Sternum fractures can be extremely painful. If the fracture is not comminuted or displaced, little can be done medically for the patient. Only time and rest will heal these injuries. Thus, we see relatively little medical treatment and small medical expenses even though the pain from these injuries is quite severe. The attorney or victim should present medical research to demonstrate the extent of disability and pain arising from these injuries. Claims adjusters frequently look first at the amount of medical charges when considering the fair amount to be paid for pain and suffering. Because little medical expense arises from these very painful injuries, you must aggressively present medical evidence and anecdotal evidence to highlight the true impact of blunt-force chest trauma.

Physicians also typically do not aggressively treat rib fractures. In fact, X-ray studies in the emergency department are typically a short series and will not reveal all rib fractures. Hospital physicians are mainly looking for organ damage and evidence of displaced rib fractures. If the ribs are not separated or fragmented, current medical protocol is to provide no treatment other than activity restrictions and pain medication.

Chest trauma also frequently results in pneumothorax or collapsed lung. Damage to the lungs and lung tissue can be extremely dangerous. Collapsed lungs can negatively affect respiration and oxygenation for the patient, and more serious pneumothorax cases can produce permanent pulmonary damage. Symptoms of collapsed lung include difficulty breathing and pain. If the pneumothorax is left untreated, the patient can transition quickly from respiratory distress to shock. Pneumothorax can be diagnosed by the absence of breath sounds or by plain-film X-ray. The X-ray will confirm an accumulation of air outside of the lungs.

Treatment of pneumothorax requires the physicians to restore the normal pressure within the chest cavity. This is done by inserting a tube into the chest wall to allow the displaced air to escape. The chest tube will remain in place for several days to make sure the lung has not only correctly reinflated but also remains properly inflated.

A hemothorax is similar to a pneumothorax except it represents an accumulation of blood instead of air within the chest cavity. This condition is usually the result of a broken rib that punctures the lung. Treatment again involves the insertion of a chest tube to remove accumulated blood and restore proper respiratory function. A “sucking chest wound” is a more serious injury involving a puncture of the chest wall that allows air to pass in and out of the chest with each breath. This condition, also known as an open pneumothorax, requires the external wound to be sealed.

Another common blunt-force chest injury is a pericardial tamponade. The heart is surrounded by a sack known as the pericardium. Pericardial tamponade occurs when blood or fluid collects within the pericardium. This fluid and pressure prevents the heart from expanding properly, thereby restricting its pumping action. This condition is typically caused by a penetrating chest injury, but it can also occur in blunt chest trauma resulting in a myocardial rupture or an aortic tear. These are extremely serious and life-threatening injuries that typically result in emergency cardiac surgery to rescue the patient.

Pulmonary contusions or bruised lungs are also common in vehicle collisions. A bruised lung is the by-product of trauma to the lung tissue, which causes blood and fluid to accumulate in the tiny air sacs of the lungs. This condition can cause breathing difficulties and sometimes progresses into a condition called acute respiratory distress syndrome (ARDS). Motor vehicle collisions involving rapid deceleration (immediate stop due to collision impact force) are the single most common cause of pulmonary contusions.

Traumatic tears to the aorta are perhaps the most frightening and dangerous injuries resulting from blunt-force chest trauma. The aorta is the major artery that carries oxygenated blood from the heart to the other arteries and areas of the body. An aortal tear is a lethal injury that carries an 80 percent prehospital mortality rate. Up to 15 percent of all auto-accident-related deaths result from injury to the aorta. This large artery is most vulnerable to injury from frontal or side impacts.

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