Chest Trauma Final 1 1230874155399897 1

3/3/2013
www.health-nursesdoctors.blogspot.com
WHAT IS IT?
Chest trauma is often sudden and dramatic Accounts for 25% of all trauma deaths 2/3 of deaths occur after reaching hospital
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WHY DO IT OCCUR?
Blunt Trauma- Blunt force to chest. E.g. automobile crashes and falls. Penetrating Trauma- Projectile that enters chest causing small or large hole. E.g. gun shot and stabbing. Compression Injury- Chest is caught between two objects and chest is compressed.
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WHAT DOES IT DO?

Rib fractures Flail chest Pulmonary contusion
Pneumothorax Haemothorax
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Rib Fracture
A rib fracture is a break in a rib bone. Cause is blunt chest trauma (fall, blow to the chest, etc).
Symptoms
Localized pain Tenderness over the fractured area on inspiration and palpation Shallow respiration atelectasis & pneumonia Pain when coughing Swelling and bruising in the fracture area Internal bleeding Pneumothorax or heamothorax
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HOW TO DIAGNOSE?
CHEST XRAY
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MANAGEMENT
Most rib fracture heals in 3 6 weeks. Generally treated conservatively with rest, local heat and analgesics. Monitor for the sign of associated injuries. Rest and do not do physical activity. Adequate pain relief
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FLIAL CHEST
The breaking of 2 or more ribs in 2 or more places, resulting in free- floating rib segments.
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The flail segment has no bony or cartilaginous connection Moves independently of the chest wall Paradoxical chest movement
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PARADOXICAL MOVEMENT The flail portion of the chest is sucked in with inspiration, instead of expanding outward Ballooned out with expiration instead of collapsing inward Hypoventilation and hypoxemia
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S/S OF FLAIL CHEST

Shortness of Breath Paradoxical Movement Bruising/Swelling Crepitus (Grinding of bone ends on palpation) Tachycardia Hypotension
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Complication: Hypoventilation Atelectasis Mediastinal flutter (mediastinal structures tend to swing back n forth) Diagnosis: Palpation : crepitus and tenderness near fractured ribs. chest x-ray ABGs www.health-nurses3/3/2013
doctors.blogspot.com
PULMONARY CONTUSION
It is damage to the lung tissues resulting in hemorrhage and localized edema. Ecchymosis at the site of the damage Crackels Cough may be present with blood-tinged sputum. Pulmonary contusions tend to worsen over a 24 to 48hour period and then slowly resolve unless complications occur (infection, ARDS). Patients with severe contusions may require endotracheal intubation and mechanical ventilation
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NURSING IMPLICATION
NURSING DIAGNOSIS Ineffective Airway Clearance Ineffective Breathing Pattern Impaired Gas Exchange Pain Risk for Infection Activity Intolerance Anxiety Decreased Cardiac output Impaired tissue perfusion Ineffective individual coping Altered health maintenance
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NURSING IMPLICATION
INTERVENTION:

Frequent and prompt Respiratory assessment Adequate oxygenation Analgesia to improve ventilation. Clearing secretion Stabilize the thoracic cage Deep breathing exercises Intubation and mechanical ventilation may be required to prevent further hypoxia
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NURSING IMPLICATION
Pain Control Alternative to relieve pain:

1. 2. 3.
Intercostal Nerve Blocks Epidural Anesthesia. Wearing a chest binder

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Maintain IV flow rates Monitor S/S of adequate tissue perfusion Anxiety reducing techniques Coping mechanism Heath education/teaching
COMPLICATIONS
Pneumonia
ARDS
Lung
abscess Emphysema Pulmonary embolism.
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PNEUMOTHORAX
Pneumothorax is a pocket of air between the two layers of pleura (parietal or visceral), resulting in collapse of the lung. TYPES : Open Pneumothorax Tension Pneumothorax
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Types
Open Laceration in the parietal pleura that allows atmospheric air to enter the pleural space; occurs as a result of penetrating chest trauma Closed Laceration in the visceral pleura that allows air from the lung to enter the pleural space; occurs as a result of blunt chest trauma www.health-nurses
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doctors.blogspot.com
Open Pneumothorax
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Open Pneumothorax
Inhale
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Open Pneumothorax Exhale
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Open Pneumothorax Inhale
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Open Pneumothorax Exhale
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Open Pneumothoarx Inhale
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Open Pnuemothorax Inhale
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Pathophysiology
Air enters the pleural space, the affected lung becomes compressed. As the lung collapses, the alveoli become underventilated, Causing V/Q mismatching and intrapulmonary shunting.
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CONT..
If the pneumothorax is large, hypoxemia ensues and acute respiratory failure quickly develops. In addition, increased pressure within the chest can lead to shifting of the mediastinum, compression of the great vessels, and decreased cardiac output
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Tension Pneumothorax
Occurs when air is allowed to enter the pleural space but not exit it; as pressure increases inside the pleural space, the lung collapses and the mediastinum shifts to the unaffected side; may be a result of a spontaneous or traumatic pneumothorax.
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Each time we inhale, the lung collapses further. There is no place for the air to escape..
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Each time we inhale, the lung collapses further. There is no place for the air to escape..
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The trachea is pushed to the good side
Heart is being compressed
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S/S OF TENSION PNEUMOTHORAX
Anxiety/Restlessness Severe Dyspnea Absent Breath sounds on affected side Tachypnea Tachycardia Poor Color
Accessory Muscle Use Hypotension Tracheal Deviation (late if seen at all) Hyperresonance to percussion
.
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Depend on the degree of lung collapse. When a pneumothorax is large, decreased respiratory excursion on the affected side may be noticed, along with bulging intercostal muscles. The trachea may deviate away from the affected side. Percussion reveals hyperresonance with decreased or absent breath sounds over the affected area. ABGs will demonstrate hypoxemia and hypercapnia. A chest x-ray film will confirm the pneumothorax with increased translucency evident on the affected side
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Assessment and Diagnosis
MEDICAL MANAGEMENT
Depending on the severity of the specific disorder. At times requires only supplemental oxygen administration, unless complications occur or underlying lung disease or injury is present. At times urgently require intervention to evacuate the air from the pleural space and facilitate re expansion of the collapsed lung.
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Treatment
Administering supplemental oxygen Inserting a large-bore needle or catheter into the second intercostal space at the midclavicular line of the affected side. This action relieves the pressure within the chest. The needle should remain in place until the patient is stabilized and a chest tube is inserted Chest tube insertion
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Needle Decompression
Locate 2-3 Intercostal space midclavicular line Cleanse area using aseptic technique Insert catheter ( 14g or larger) at least 3 in length over the top of the 3rd rib( nerve, artery, vein lie along bottom of rib) Remove Stylette and listen for rush of air Place Flutter valve over catheter Reassess for Improvement
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Needle Decompression
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Nursing Diagnosis
Impaired Gas Exchange related to ventilation/ perfusion mismatching or intrapulmonary shunting Ineffective Breathing Pattern related to decreased lung expansion Acute Pain related to transmission and perception of cutaneous, visceral, muscular, or ischemic impulses Anxiety related to threat to biologic, psychologic, and/or social integrity Disturbed Body Image related to actual change in body structures, function, or appearance Compromised Family Coping related to critically ill www.health-nursesfamily member doctors.blogspot.com
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NURSING INTERVENTIONS
Continuous
assessment Optimizing oxygenation and ventilation, Maintaining the chest tube system Providing comfort and emotional support Maintaining surveillance for complications.
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and vigilant respiratory
Hemothorax
Occurs when pleural space fills with blood Usually occurs due to lacerated blood vessel in thorax As blood increases, it puts pressure on heart and other vessels in chest cavity Each Lung can hold 1.5 liters of blood
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Hemothorax
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Hemothorax
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Hemothorax
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Hemothorax
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Hemothorax
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Hemothorax
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May put pressure on the heart
Hemothorax
Where does the blood come from.
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Lots of blood vessels
S/S of Hemothorax
Anxiety/Restlessness Tachypnea Signs of Shock Frothy, Bloody Sputum Diminished Breath Sounds on Affected Side Tachycardia

Flat Neck Veins

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Treatment for Hemothorax

ABCs Secure Airway assist ventilation if necessary General Shock Care due to Blood loss

RAPID TRANSPORT to hospital.
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Summary
Chest Injuries are common and often life threatening in trauma patients. So, Rapid identification and treatment of these patients is paramount to patient survival. Airway management is very important and aggressive management is sometimes needed for proper management of most chest injuries.
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Chest Trauma Final 1 1230874155399897 1

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3/3/2013

WHAT DOES IT DO?

Rib fractures Flail chest Pulmonary contusion

S/S OF FLAIL CHEST

Pain Control Alternative to relieve pain:

Intercostal Nerve Blocks Epidural Anesthesia. Wearing a chest binder

abscess Emphysema Pulmonary embolism.

Open Pneumothorax Exhale

Open Pneumothorax Inhale

Open Pneumothorax Exhale

Open Pneumothoarx Inhale

Open Pnuemothorax Inhale

Heart is being compressed

S/S OF TENSION PNEUMOTHORAX

Assessment and Diagnosis

and vigilant respiratory

May put pressure on the heart

Lots of blood vessels

Flat Neck Veins

Treatment for Hemothorax

RAPID TRANSPORT to hospital.

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