Accident · casualty · Chest Trauma · Education · first responder · paramedic · police · Trauma ·

Torso Trauma: Recognition and Response

 

(warning: this article contains graphic images)

In the critical first minutes after torso trauma, a patient can rapidly lose life-threatening amounts of blood volume with minimal external signs. This poses a unique challenge for first responders, who must recognise and respond to haemorrhage that may be hidden from immediate view. According to the NSW Agency for Clinical Innovation's Major Trauma Report (2020-21), among major trauma patients admitted to NSW trauma services, chest injuries (54.2%) and head/neck injuries (52.2%) were the most common injury sites, with many of these cases involving significant blood loss that demands immediate action.

First responders encounter torso haemorrhage in various scenarios - motor vehicle accidents, falls from height, sporting incidents, and assaults. While external bleeding presents visible challenges, internal haemorrhage can be deceptively dangerous, requiring trained eyes to recognise early warning signs before shock sets in.

Our comprehensive guide to torso bleeding builds on RTACC and ANZCOR guidelines to provide evidence-based approaches for first responders. We'll explore critical assessment frameworks, intervention techniques, and real-world cases that demonstrate key principles in action.

 

Understanding Torso Haemorrhage

Torso haemorrhage occurs when blood vessels in the chest or abdomen regions are damaged, leading to potentially catastrophic blood loss and other complications. These injuries commonly result from penetrating trauma (such as stab wounds or gunshot wounds) or blunt force trauma (such as motor vehicle accidents or falls)

When assessing torso haemorrhage, we must be prepared for two distinct patterns:

External Haemorrhage:

  • Immediately visible blood loss
  • 90% of external haemorrhaging can be controlled
  • Rapid intervention with direct pressure

Internal Haemorrhage:

  • May only present with signs of shock
  • Can be more dangerous than external bleeding
  • Requires heightened awareness of shock symptoms and rapid transportation

 

 

The Critical First Minute

The RTACC manual emphasises achieving haemorrhage control within 60 seconds, so let’s breakdown that timeline:

0-15 seconds:

  • Scene safety assessment
  • Don appropriate PPE
  • Use Trauma Shears to quickly expose the area and identify bleeding
  • Clear access to bleeding site

15-30 seconds:

  • Fully expose the wound
  • Quick visual assessment of blood loss
  • Note wound characteristics (size, depth, location)
  • Look for exit or secondary wounds

30-60 seconds:

 

Managing Mechanisms of Torso Trauma

While torso trauma can result from blast, thermal, and crush injuries, blunt and penetrating injuries are most common in civilian emergencies. Each mechanism creates distinct injury patterns requiring systematic assessment and rapid intervention.

Blunt Trauma

Blunt trauma to the torso, commonly seen in vehicle accidents, falls, and assault, presents unique assessment challenges due to the potential for significant internal injury.

 

Assessment Priorities:

  • Expose and thoroughly check the entire torso: Blunt force trauma can cause injuries far from the impact site.
  • Observe chest movement during breathing: Unequal rise and fall may indicate serious injury.
  • Listen to both sides of the chest: Different sounds may suggest internal injury.
  • Gently palpate the torso for pain, instability, or crepitus (crackling/bubbling).
  • Identify and document any visible signs of injury, such as bruising, swelling, or deformities.

High-Risk Indicators:

  • Visible signs of significant force transfer (e.g., seat belt marks, impact patterns)
  • Increasing chest or abdominal girth that suggests internal haemorrhage
  • Bruising appearing in specific areas, particularly around the sides of the torso or around the belly button
  • Referred pain patterns suggesting deep injury
  • Normal-looking skin can mask serious internal injuries - a lack of visible trauma does not rule out severe injury

Case Study 1: Hidden Thoracic Trauma
A 36-year-old motorcyclist was initially stable following a high-speed collision. Prior to hospital transfer, he was considered stable but had suffered multiple rib and lower extremity fractures. Upon arrival to a trauma centre, "he became unresponsive and tachycardic and had a blood pressure of 56/42. He was intubated and underwent bilateral chest tube placement and aggressive fluid resuscitation."

After 11 days of ongoing issues, the patient was found to have severe internal chest injuries despite minimal external signs. He required surgery to repair a large tear in his pericardium where his heart had herniated through and was compressing his left lung.

While rare, this case highlights the challenge of diagnosing severe internal chest injuries, even with modern imaging. First responders should maintain a high index of suspicion for internal injuries in all cases of blunt chest trauma, even when external signs are minimal.

The full case study can be read here.

 

Penetrating Trauma

Penetrating trauma to the torso, commonly seen in stabbings, shootings, and impalement injuries, requires immediate intervention due to the high risk of significant tissue and organ damage.

 

 

Assessment Priorities:

  • Expose and check the entire torso: Penetrating injuries often have multiple entry and exit points that may be concealed by clothing or blood.
  • Use Trauma Shears to carefully remove clothing without disturbing any embedded objects.
  • Look for bubbling or sucking sounds from chest wounds which indicate an open pneumothorax.
  • Check for signs of active bleeding that needs to be rapidly controlled.
  • Document the location, size, and characteristics of all wounds for handover to emergency services.

High-Risk Indicators:

  • Embedded objects which may be tamponading major blood vessels.
  • Asymmetrical chest movement or abnormal breathing suggests pneumothorax.
  • Multiple entry or exit wounds, particularly with gunshot injuries.
  • Wounds near vital structures such as the heart or major blood vessels.
  • Progressive difficulty breathing or increasing chest pain.
  • Signs of developing shock.

 

 

Shock Management

Early recognition and management of shock is critical in torso trauma. Shock occurs when there is inadequate blood flow to vital organs, often due to blood loss from internal or external haemorrhage.

High-Risk Indicators:

  • Changes from initial mental status: Confusion or agitation may signal decreased brain perfusion
  • Increasing heart rate: Rapid, thready pulse often precedes more serious signs of shock
  • Rapid shallow breathing.
  • Deteriorating blood pressure (if measurable).
  • Cool, pale skin progressing to cold, mottled extremities.
  • Delayed capillary refill (>2 seconds).

Management Principles:

  • Position patient supine unless contraindicated.
  • Maintain body temperature using emergency blankets: Hypothermia can worsen your patient’s condition significantly.
  • Document all observations and interventions.
  • Prepare for rapid transport: Definitive care is essential.
  • Reassess frequently: Shock can develop rapidly in torso trauma.

 

 

DO NOT - Critical Points from the RTACC Manual

To avoid worsening torso haemorrhage:

  • DO NOT remove impaled objects.
  • DO NOT delay transport for non-essential interventions.
  • DO NOT apply direct pressure to suspected fracture sites.
  • DO NOT waste time with improvisations like three-sided dressings.
  • DO NOT overlook multiple injury sites during assessment.
  • DO NOT forget to regularly reassess after interventions.

 

Your Essential Takeaways

The RTACC manual emphasizes that 90% of external haemorrhaging can be controlled with well-performed direct pressure, but patient outcome depends on rapid recognition and decisive intervention.

Key points to remember:

  • The first 60 seconds are critical
  • Use MARCH assessment systematically
  • Trust your clinical judgment
  • Early transport saves lives
  • Regular reassessment is essential

More key learnings from the TacMed Learning Centre:

 

While this guide provides a framework for managing torso haemorrhage, nothing replaces proper training and regular skill maintenance. Keep your trauma kit stocked, your skills sharp, and your guideline knowledge current.

Stay Safe,

Team TacMed

 

Note: Always follow current ANZCOR guidelines and seek immediate emergency medical care in any trauma situation. This information supplements but does not replace proper first aid training.

 

References:


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