Blunt Chest Trauma

Question 1

What are two types of Blunt Chest Trauma ?

Answer 1

• Fractures of ribs and sternum

- Flail chest (occurs with multiple rib fractures)

Question 2

What are the most common injuries from chest trauma ?

Answer 2

• Fractures of the ribs and sternum

- Usually ribs 5-9 (b/c they are least protected by chest muscles)

Question 3

What are the signs & symptoms of fractures to the ribs and sternum ?

Answer 3

• Pain & tenderness
• Crepitus (bones grating together)
• Shallow respirations
• Respiratory acidosis (retaining CO2)

Question 4

What are the Tx’s for for Fractured ribs and sternum

Answer 4

• Non-narcotic analgesic (don’t want to suppress breathing)
• Incentive spirometry
• Nerve block to assist with productive cough
• Support injured area with hands
• Observe for other complications
  (such as; pneumothorax, hemothorax, and flail chest)

Question 5

What should you NOT do for Tx of fractures of the ribs and sternum ?

Answer 5

IT IS NOT RECOMMENDED to immobilize the chest with binders and straps!!

b/c it leads to shallow breathing, atelectasis, and pneumonia

Question 6

What are the signs & symptoms of Flail Chest ?

Answer 6

• Anxious
• SOB
• Pain
• Paradoxical chest wall movement
• Dyspnea
• Cyanosis
• Increased pulse

Question 7

What is Paradoxical chest wall movement ?

Answer 7

(see-saw chest)

chest sucks inwardly on inspiration and puffs out on expiration

(to assess chest symmetry, always stand at the foot of the bed to observe how the chest is rising and falling)

Question 8

How should you assess chest symmetry ?

Answer 8

Always stand at the foot of the bed to observe how the chest is rising and falling

Question 9

What are the Treatment’s for Flail Chest ?

Answer 9

• Humidified oxygen
• Pain management
• Stabilize the area
• Intubate
• Ventilate
• Positive pressure ventilation (stabilizes the area and promotes lung expansion)

Question 10

What are the two types of Positive pressure ventilation ?

Answer 10

• Invasive positive pressure ventilation

- Non-invasive positive pressure ventilation

Question 11

Is PEEP seen with….

Invasive positive pressure ventilation

OR

Non-invasive positive pressure ventilation ?

Answer 11

Invasive positive pressure ventilation

Question 12

What does PEEP stand for ?

Answer 12

Positive End Expiratory Pressure

Question 13

With PEEP, the client is on what ?

Answer 13

a Ventilator

Question 14

How does PEEP work ?

Answer 14

At the end of expiration the ventilator exerts pressure down into the lungs to keep the alveoli open

Question 15

What are the benefits of PEEP ?

Answer 15

• Improves gas exchange and decreases the work of breathing

- It expands and re-aligns the ribs so they can start growing back together

Question 16

PEEP may also be used to treat what ?

Answer 16

• Pulmonary edema

- Severe hypoxemia

Question 17

What is the classic reason to use PEEP ?

Answer 17

for treating Acute Respiratory Distress Syndrome (ARDS)

Question 18

What are two types of Non-invasive positive pressure ventilation ?

Answer 18

• BiPAP and CPAP

Question 19

How does Non-invasive positive pressure ventilation (biPAP & CPAP) work ?

Answer 19

BiPAP & CPAP apply pressure to the lungs to open up the alveoli and improve ventilation and oxygenation

Question 20

Both BiPAP & CPAP are used for what types of things ?

Answer 20

• Sleep apnea
• ARD’s
• COPD
• Pulmonary edema

Question 21

Clients being weaned from a ventilator may be moved to what ?

Answer 21

Non-invasive positive pressure ventilation

such as, BiPAP & CPAP

Question 22

What does CPAP stand for ?

Answer 22

Continuous Positive Airway Pressure

Question 23

Who does CPAP work ?

Answer 23

Pressure is delivered continuously during inspiration and expiration

Question 24

In what situations is CPAP used for ?

Answer 24

• Obstructive sleep apnea

- Infants with underdeveloped lungs

Question 25

In clients with COPD, too much oxygen will do what ?

Answer 25

Suppress respiratory drive

no more than 2L unless emergency

Question 26

What does BiPAP stand for ?

Answer 26

Bi-level Positive Airway Pressure

Question 27

How does BiPAP work?

Answer 27

Pressure is applied at two different pressure settings. One pressure on inhalation and a lower pressure on exhalation

Question 28

For who is BiPAP used on ?

Answer 28

Most often used with clients who have non-obstructive sleep apnea

b/c it is better tolerated since they don’t have to exhale against a high pressure

Question 29

Anytime you see PEEP, CPAP, or Bi-PAP, your priority nursing assessment is what ?

Answer 29

Is to check bilateral lung sounds (Q2H)

(pressure could pop lung?) - pg. 167