What are chest injuries?

Chest injuries are injuries to the chest area — anywhere between the neck and the abdomen. Damage may be to the chest wall — the bones (including ribs and sternum), skin, fat and muscles protecting your lungs — or any of the organs inside the chest (for example the heart or lungs).

Chest injuries can be minor, such as bruising, or serious problems that need urgent medical attention. They may be caused by blunt force or by a penetrating injury.

Chest injuries include:

• bruising or abrasions to the chest area
• broken bones — for example, a rib fracture or fractured sternum (breastbone)
• flail chest — where multiple ribs next to each other are broken and that segment of the chest wall moves separately to the rest
• damage to the heart, for example, blunt injury to the heart, or injury to the aorta — the main artery that delivers blood to the rest of your body
• damage to the lungs — for example, bruising (pulmonary contusion)
• penetrating chest wounds — these can damage the chest wall and any of the internal organs within the chest
• injuries to the oesophagus (food pipe), trachea (windpipe) or diaphragm

Fractured ribs

One of the most common chest injuries is fractured ribs (‘broken ribs’). where a rib cracks or breaks. These may be caused by a strong blunt force, such as a fall from a height or a motor vehicle crash. In older people who have osteoporosis, only a slight force, such as a minor fall, or even a cough or sneeze, can fracture a rib.

A fractured rib is rarely serious. However, the force that caused the fracture can occasionally cause other problems, such as a bruised or collapsed lung, so it’s important to seek medical attention if you think you may have a fractured rib.

Flail chest

Flail chest may occur if several ribs next to each are broken in more than one place. This is a life-threatening condition, where part of the chest wall moves in the opposite direction to the rest when a person breathes.

What are the symptoms of chest injuries?

Symptoms of chest injury can vary, depending on the type of injury. Signs and symptoms of chest injury include:

• pain in the chest that gets worse when laughing, coughing or sneezing
• pain when breathing in
• difficulty breathing
• tenderness to the chest or back over the ribs
• bruising
• swelling
• a ‘crunchy’ or ‘crackling’ feeling under the skin or in the ribs
• coughing up blood

What causes chest injuries?

Chest injuries may be caused by:

• a blunt injury, such as from sport, from a punch or kick, or from a fall or motor vehicle accident
• a penetrating wound, such as from a gunshot or a knife

When should I call an ambulance?

Chest injuries that interfere with breathing or circulation can be serious or life threatening.

If the injury is severe, there may be internal bleeding. This might be obvious (e.g. coughing up blood), or not so obvious (e.g. pale and clammy skin, nausea, extreme thirst).

Go to an emergency department or call an ambulance on triple zero (000) if you or the patient:

• have difficulty breathing
• feel drowsy or confused
• cough up any yellow/green or red-stained sputum or blood
• have skin that is clammy and pale or blue
• have chest pain, especially if it's increasing
• pass any blood in your urine and or stools
• are thirsty
• have a temperature or fever

What should I do while waiting for the ambulance?

First aid for a chest injury will depend on the type of injury, but basic first aid follows the DRSABCD action plan.

If the wound is a penetrating chest wound, there are some additional first aid steps (see below). Penetrating wounds are made when an object punctures the chest wall. Examples of a penetrating chest wound include gunshot wounds, stabbing wounds, arrow wounds and wounds from blast fragments.

For a penetrating chest wound

• follow DRSABCD action plan
• If the person is unconscious and breathing, position them in the recovery position with the injured side down
• If the person is conscious, help them sit in a comfortable position, such as half sitting, leaning to the injured side
• if any part of the chest is bleeding, cover the area with a clean cloth or bandage, and apply consistent pressure to stop the bleeding — if this makes things worse, remove immediately
• if an object remains in the chest, it should NOT be removed
• check for an exit wound
• CPR may be necessary

How are chest injuries diagnosed?

A chest injury is diagnosed with a physical examination and sometimes investigations such as a chest x-ray, ultrasound or CT scan. The doctor may monitor the oxygen saturation of your blood using a small device called a pulse oximeter, clipped to your finger.

For a rib fracture, sometimes doctors can feel the broken ribs when they gently press the affected area. Sometimes rib fractures don’t show on a chest x-ray. If you appear well and the doctor doesn’t suspect complications, you may not need an x-ray. Your doctor may order a chest x-ray to look for any serious problems related to the fractured rib, such as a bruised or collapsed lung.

How are chest injuries treated?

Treatment of the chest injury will depend on the cause of the injury and how serious it is. If you have a severe chest injury, you will be admitted to the hospital. The medical team will support breathing and circulation if necessary. You may be given oxygen and intravenous fluids or blood transfusions. Pain relief will be given if needed.

A fractured rib will heal on its own, but it takes time — up to 8 weeks. If you have a fractured rib, you may be asked to breathe deeply regularly and cough to keep the air sacs in the lung open and prevent pneumonia, a type of chest infection. If you are in pain, take pain-relief medicines. Pain relief is important so you will feel more comfortable to cough, take deep breaths and do any breathing exercises you are given.

If your injury is minor, try to keep moving around and doing what you normally do. But avoid lifting, bending and any strenuous exercise until your pain and other symptoms have gone.

What are the complications of chest injuries?

One of the most common complications of rib fracture or chest injury is a chest infection.

Other less common complications of chest injuries include:

• haemothorax — blood in the space surrounding the lung
• pneumothorax (punctured or collapsed lung) — air in the space surrounding the lung
• surgical emphysema — air trapped under the skin can cause a swollen area on the chest wall
• abdominal injuries — liver or spleen damage can cause pain in your stomach or back
• torn aorta — a break in one of the top ribs can damage the aorta or other blood vessel

Call healthdirect on 1800 022 222 (known as NURSE-ON-CALL in Victoria) for advice if:

• your symptoms get worse
• you develop new symptoms
• you become increasingly concerned