29.4 Respiration and Chest Trauma Flashcards
The ______ of the chest is where the trachea, pulmonary arteries and pulmonary veins are located.
hilum
Blood vessels of the chest
(a)Great vessels
(b)Pulmonary arteries
(c)Intercostal vessels
(d)Internal Mammary artery
The two components of chest physiology that are most likely to be impacted by injury are
Breathing and circulation
Types of Pneumothorax
- Simple: is the presence of air within the pleural space
- Open: also called “sucking chest wound”
- Tension: occurs when air continues to enter the pleural space but has no avenue for egress
Assessment: Demonstrate findings similar to those in rib fracture:
1)Chest pain
2)Dyspnea
3)Tachycardia
4)Decreased breath sounds on affected side
Simple pneumothorax
Treatment of simple pneumothorax
1)Monitor casualty closely for development of tension pneumothorax and the need for decompression.
2)Administer supplemental oxygen.
3)Obtain IV access.
4)Be prepared to treat shock if it develops.
5)Rapid transport is essential if functioning at a basic Level 1.
6)If MEDEVAC by air you must either perform needle decompression or place a chest tube so that it does not become a tension pneumothorax in the air.
Simple pneumothorax may become a what at any moment
Tension pneumothorax
Assessment: Generally, reveals obvious respiratory distress.
(1 Dyspnea
(2 Sudden sharp pain
(3 Subcutaneous Emphysema
(4 Decreased lung sounds on affected side
(5 Red Bubbles on Exhalation from wound (aka “Sucking Chest Wound”)
Open Pneumothorax
Treatment of Open Pneumothorax
- closing the defect in the chest wall and administering supplemental oxygen
- Occlusive dressing
- If these measures fail to support the casualty adequately, endotracheal intubation and positive - pressure ventilation may be necessary.
- needle decompression or chest tube
Emergency needle decompression is performed to relieve a
tension pneumothorax
Needle decompression should be performed when the following three criteria are met
(a)Evidence of worsening respiratory distress or difficulty with BVM device.
(b)Decrease or absent breath sounds
(c)Decompensated shock (SBP <90mm Hg)
Simple pneumothorax usually occurs in
1)Young white males
2)Age 16 to 25 years old
3)Who possess a very lanky, thin, runner’s build
Signs and Symptoms:
(a) Present with dyspnea, anxiety, tachycardia,hypotension and hypoxia.
(b)Jugular venous distention and midline tracheal shift are classically described butrarely present.
(c)Hypotension is an ominous sign that signifies obstructive shock
tension pneumothorax
- The patient is at rest and feels a popping sensation within the chest.
-The patient wakes up in the morning and feels short of breath. - Chest pain on the affected side
- Dyspnea / Shortness of Breath
- Symptoms usually begin during rest or sleep
Simple pneumothorax
Anatomical landmarks for Needle D
(1) Mid-clavicular line
(2) Sternum
(3) Jugular Notch
(4) 2nd Intercostal Space
(5) Second Rib
(6) Clavicle
What should be monitored after needle d
(a)Respiratory rate
(b)Lung sounds
(c)The patient’s color
(d)Continue to monitor the patient and reassess frequently
Hemothorax occurs when blood enters the pleural space. Because this space can accommodate between
2500 and 3000 mL
The mechanisms resulting in hemothorax are the same as those causing the various types of pneumothorax. The bleeding may come from
the chest wall musculature, the intercostal vessels, the lung parenchyma, pulmonary vessels, or the great vessels of the chest
The primary cause of hemothorax
lung laceration orlaceration of an intercostal vessel or internal mammary artery due to eitherpenetrating or blunt trauma.
Assessment: Casualty may appear in distress with the following signs andsymptoms:
(a)Anxiety / Restlessness
(b)Chest Pain
(c)Tachypnea
(d)Signs of Shock (pallor, confusion, hypotension)
(e)Frothy, Blood Sputum
(f)Diminished Breath Sounds on Affected Side
(g)Tachycardia
(h)Flat Neck Veins
hemothorax
Treatment of hemothorax
(a)Serial observation to detect physiologic deterioration while providingappropriate support
(b)High-concentration oxygen, ventilation support if necessary with BVM or moreadvance techniques
(c)General Shock Care due to blood loss
(4) Consider left lateral recumbent position if not contraindicated.
(5) RAPID TRANSPORT to appropriate facility (Level of Care).
Indications for Chest Tube
(1) Drainage of large pneumothorax (> 25%)
(2) Drainage of hemothorax
(3) After needle decompression of a tension pneumothorax
(4) Pleural effusion
(5) Empyema
(6) Simple/Closed Pneumothorax
(7) Open Pneumothorax
Contraindications for Chest Tube
(1) Infection over insertion site
(2) Uncontrolled bleeding (diathesis)
(3) No contraindication if the procedure is emergent
Chest Tube sizes
1)Adult or Teen Male - 28-32 FR
2)Adult to Teen Female - 28 FR
3)Child - 18 FR
Landmark for Chest tube
At the fifth intercostal space in the midaxillary line
How often should chest tube dressings be changed?
Every 24 hours or sooner if it becomes saturated
The breaking of 2 or more ribs in 2 or more places is termed
Flail Chest
Casualty may appear in distress with the following signs and symptoms:
1)Shortness of Breath
2)Paradoxical Chest Movement
3)Bruising/ Swelling of affected chest area
4)Crepitus (Grinding of bone ends on palpation)
Flail chest
Treatment of flail chest
1)Adequate ventilation
2)High flow oxygen that may include BVM
3)IV fluids
4)Analgesia to improve ventilation (local anesthetic). If giving IV pain controldo not use pain medication that decreases respiratory drive unless onmechanical ventilation or someone that sole job is bagging the patient.
5)Monitor patients for signs of Pneumothorax or Tension Pneumothorax
6)Use gloved hand as splint till bulky dressing can be put on patient
7)RAPID TRANSPORT to appropriate facility (Level of Care)
What medication can be given for pain for flail chest
ketamine, Precautionsshould be taken with morphine sulfate because it can depress respiration
A bruise of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue.
Pulmonary Contusion
What is almost always present in a casualty with flail chest
Pulmonary contusion
The chief physiological abnormality with pulmonary contusion
Prevention of gas exchange because no air enters these alveoli. Blood and edema fluid in the tissue between the alveoli further impedes gas exchange in the alveoli that are ventilated
Treatment of flail chest
(a)Support of ventilation
(b)Supplemental oxygen
(c)Meticulous reevaluation (repeatedly reassess the respiratory rate and check pulse oximetry) ensure that O2 sat are at least 95% of better.
(d)Support ventilation with BVM or endotracheal intubation may be necessary.
(e)IV fluids should be limited to keep vein open (KVO) unless the casualty is hemodynamic compromised, because excess fluid may further increase edema and compromise ventilation and oxygenation.
