Chest Trauma (Chest Injury)

First aid for a chest injury

1. Call 911 or your local emergency number for any serious chest injury or breathing difficulty.
2. Help the person sit up, leaning toward the injured side if that eases breathing, unless a spinal injury is suspected.
3. Open chest wound: cover it with a clean dressing or your gloved hand. Do not seal it airtight with tape on all sides. Dispatchers may advise a vented dressing. If breathing worsens after covering, briefly lift the dressing.
4. Do not remove an object stuck in the chest. Pad around it to keep it still.
5. If the person collapses and is not breathing normally, start CPR and use an AED.
6. Keep them warm and still until help arrives.

Types of chest injury

Chest wall injuries

• Bruised chest wall: pain and tenderness without a fracture. Heals in 1 to 3 weeks.
• Rib fracture: the most common chest injury. Sharp pain on breathing, coughing and moving, with a tender spot on the rib. Older adults are at much higher risk of complications such as pneumonia.
• Flail chest: several ribs broken in two or more places, so a segment of chest wall moves inward when breathing in. A serious injury that often comes with lung bruising.
• Sternal fracture: a break in the breastbone, usually from a seatbelt or steering wheel.

Lung injuries

• Pneumothorax: air leaks into the space around the lung and collapses it, causing sudden breathlessness and sharp pain. A tension pneumothorax, where pressure builds and pushes on the heart, is immediately life-threatening.
• Hemothorax: blood collects around the lung, from torn vessels or lung tissue.
• Pulmonary contusion: bruising of the lung tissue, which can worsen over 24 to 48 hours and cause low oxygen levels.

Heart and blood vessel injuries

• Cardiac contusion (blunt cardiac injury): bruising of the heart muscle, which can cause abnormal rhythms.
• Cardiac tamponade: blood collects around the heart and stops it filling, causing low blood pressure and swollen neck veins. Usually from penetrating injuries.
• Aortic injury: a tear in the main artery from sudden deceleration in high-speed crashes or falls. Often fatal at the scene, but some people reach hospital and need urgent repair.
• Commotio cordis: a blow to the chest at a precise moment in the heartbeat, typically from a baseball, hockey puck or lacrosse ball, triggers cardiac arrest. Immediate CPR and defibrillation save lives.

Other

• injuries to the windpipe, esophagus or diaphragm
• injuries to the liver or spleen from lower rib fractures

Symptoms

• chest pain, often worse with breathing, coughing or movement
• shortness of breath
• bruising, tenderness or a crackling feeling under the skin (air under the skin)
• coughing up blood
• fast heart rate, low blood pressure, fainting
• reduced movement of one side of the chest

Diagnosis

In the ER, the team assesses airway, breathing and circulation first. Tests include:

• chest X-ray for fractures, collapsed lung and blood
• bedside ultrasound (FAST/eFAST) to look for blood around the heart, lungs and abdomen and for pneumothorax
• CT scan for detailed views of ribs, lungs, heart and aorta
• ECG and blood tests, including troponin, for heart injury
• oxygen levels and blood gases

Not every rib fracture shows on X-ray, so treatment is often based on symptoms.

Treatment

Minor injuries and rib fractures

• Pain control is the most important treatment, because it allows deep breathing and coughing. Acetaminophen (paracetamol) and anti-inflammatories are often used. Stronger pain relief or nerve blocks are given in the hospital for multiple fractures.
• Deep breathing exercises: take 10 slow, deep breaths every hour while awake, and cough gently while holding a pillow against the chest. An incentive spirometer may be provided.
• Stay active: walk around and avoid lying flat all day.
• Do not strap the chest: binding the ribs restricts breathing and raises pneumonia risk.

Rib fractures typically heal in about 6 weeks, though pain often improves after 2 to 3 weeks.

Serious injuries

• Chest tube: a tube between the ribs drains air or blood from around the lung.
• Needle decompression for tension pneumothorax.
• Oxygen and breathing support, including a ventilator for severe lung bruising or flail chest.
• Surgical rib fixation for flail chest or severely displaced fractures in some patients.
• Surgery to repair the heart, lungs, aorta or other organs.

Complications

• pneumonia, especially in older adults with rib fractures
• delayed collapse of the lung or bleeding
• chronic chest wall pain
• infection of collected blood (empyema)

Frequently asked questions

How do I know if a chest injury is serious?

Get emergency care if you have difficulty breathing, fast breathing, blue lips, coughing blood, fainting, an open wound, or severe or worsening pain. Any chest injury from a high-speed crash, a fall from height or a crush should be checked in the ER even if you feel well.

How long does a bruised chest take to heal?

A bruised chest wall usually heals in 1 to 3 weeks. Broken ribs take about 6 weeks to heal, though pain often eases after 2 to 3 weeks. If pain is not improving, or you develop fever or worsening breathlessness, see a doctor.

Should I wrap my chest after a rib injury?

No. Wrapping or strapping the chest makes it harder to breathe deeply, which increases the risk of pneumonia and lung collapse. Instead, take pain relief, do deep breathing exercises every hour and hold a pillow against your chest when coughing.

Can a hit to the chest stop your heart?

Yes, rarely. Commotio cordis happens when a blow to the chest, often from a ball in sports, strikes at a vulnerable moment in the heartbeat and triggers cardiac arrest. Immediate CPR and use of an AED are lifesaving. Chest protectors may reduce the risk.