This week I wanted to talk about chest injuries and the problems associated with them. How do you know if you have really done yourself a serious injury? Let’s face it, they all hurt a lot, so what can be done to prevent these injuries?
What exactly are we talking about? When you fall on to your chest, or your back, your ribs stop you from damaging your internal organs i.e. your heart, lungs and to a certain extent, your liver and spleen. The classic injury is a fall on to the snow, ‘winding’ the victim and leaving significant pain on movement and inspiration thereafter. This can often happen if you land on an arm that is tucked into the chest (usually in snowboarders), which can lead to a good going rib fracture. If you’re really unlucky, to add insult to injury, your board or skis may come up behind you and collide with your head: The classic Scorpion.
Back to chest injuries, the spectrum of damage is limitless. We see these injuries most days. The majority have suffered a tear in the muscles between the ribs. These are called the intercostal muscles and help you to breathe in. Unfortunately you can’t take a rest from breathing so this hurts a lot, especially as they have a rich nerve supply. Next up is the broken rib. This is a diagnosis made on examination and not on x-ray as most people believe. The majority of rib fractures do not cause problems and are difficult to see on x-ray film, so they are not routinely done. The treatment is good painkillers, rib strapping which takes the pressure away from the injury and instructions to take deep breaths regularly. Yes, this hurts a lot but it also keeps the miniature passageways open, discouraging bacteria from growing, because if you start coughing, that injury will really hurt.
“Have I popped my lung?” is a common question we get asked. The answer is usually no. So what is a popped lung? Excuse the analogy, but imagine that your fist is a lung, now put your fist into a half blown up balloon. It is now surrounded by two layers, right? These are called the pleura. If the outer layer is speared by, for example, a fractured and displaced rib, then suddenly air can enter the space between the layers and cause your lung (the fist, if you are still following) to shrink down. This is called a pneumothorax or collapsed lung. Usually, it’s not a problem, if you are young and fit, then it will re-inflate spontaneously over days or weeks, but a large one will cause you to feel breathless, contribute to pain and may need intervention in hospital (about four percent). Smokers are at greater risk of this injury.
The liver (right) and spleen (left) are also protected by ribs. However these ribs are called floating ribs as they are only fixed at the front but not the back. A blow to the left or right hand side, typically because of an overlying arm or by landing on a rail can damage these organs. They are delicate and have a very rich blood supply. They are each surrounded by a capsule which stems the bleeding in an accident, but once this bursts, the result can be fatal. If you notice a pain in the upper left or right of the abdomen (lower chest) then think about going to see the doctor. A racing pulse is another indication.
How do you prevent this from happening? Well, short of becoming a better skier/snowboarder, avoid carrying objects such as phones/keys/wallets in pockets around the ribcage. Avalanche transceivers are often a problem due to the strapping system, try to have these in the middle of the abdomen away from organs. In short, the difference between a muscle or rib problem compared to a collapsed lung is often a feeling of shortness of breath, so get yourself looked at.
Abdominal pain or racing pulse as described above should also be investigated. If you are worried about an injury, always go and see your doctor.
Tags: S5E13
