When you think about lung damage, you might think about pneumonia, but not all damage to the lungs and chest is related to inflammation due to infections. Trauma is also a possibility, especially for those of us who venture off the grid for activities such as hunting, hiking, or mountain biking. In austere settings, a family medic may have to deal with injuries that can sometimes be lethal without immediate intervention. Penetrating chest wounds often fall into this category.
First, some anatomy: The lungs are protected by the rib cage. Humans have 12 pairs of ribs, numbered from top to bottom. These are sometimes called “true ribs,” “false ribs,” and “floating ribs.” The true ribs (ribs 1 to 7) connect to the sternum (breastbone) via flexible connective tissue called cartilage. The false ribs (8 to 10) connect not to the sternum itself, but to the cartilage of the 7th rib instead. The 11th and 12th ribs “float” in front, with no connection to the breastbone at all. All ribs, however, connect to the spine in back. Ribs are also connected to each other by muscles (called intercostal muscles). Nerves and blood vessels travel just under each rib in the intercostal space.
Rib Fractures
Once significant trauma impacts the rib cage, fractures may occur. Rib fractures most often involve the middle ribs. If a rib is broken, you may note the following:
> Pain, sometimes with a palpable bump or dent at the site of impact
> Increased discomfort with breathing or movement
> Bruising of the chest or back
> Grating sensations or sounds when fractured bone ends rub against each other (use a stethoscope over the area to listen)
