Fractured Clavicle:
The clavicle tends to break in center to distal 1/3, the fracture is tender and palpable.
Sling & swathe on the affected side.
Concerns: Monitor for shortness of breath, possible pneumothorax.

Fractured Scapula:
Is a very uncommon injury, requires a direct blow to the scapula.
Sling & swathe on the affected side.
Concerns: Monitor for signs of respiratory distress.

Fractured Ribs:
Point tenderness over the ribs, may have crepitation with deep breathing.
Increasing pain with deep breathing.
Monitor for increasing shortness of breath.
If, on physical exam there are decreased breath sounds on one side = pneumothorax.
Sling & swathe to support injured side, and monitor for tension pneumothorax.

Flail Chest:
Two or more ribs are broken in two or more places that causes a free floating section.
This is a true life-threatening injury, evacuate ASAP.
Positive pressure ventilation, with 100% O2 if possible.
Position of comfort to support respirations.
Beware of taping bulky dressings that can depress the flail section making it more difficult to breath.

Sucking Chest Wound:
Hole in the chest wall that extends into the pleural space allowing are to move in and out of the pleural space interfering with breathing.
Airproof dressing that is taped down on 3 sides over the wound effectively creating a one-way valve.
This allows the air to vent from the pleural space helping to prevent a tension pneumothorax.
Monitor for signs of respiratory distress and a tension pneumothorax.

Pneumothorax & Tension Pneumothorax:
A pneumothorax is air escaping into the pleural space causing the lung to collapse.
A tension pneumothorax occurs when the pressure on the side of the collapsed lungs builds up to the point where it compresses the heart and compromises circulation.
Monitor for respiratory distress.
If tension occurs with tracheal deviation, JVD, and 1 -2 word dyspnea they may need a needle thoracostomy or place a chest tube to decompress the tension and restoring circulation and improving air exchange.

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