Chest Trauma

Question 1

injuries causing chest trauma are separated into two categories:

Answer 1

blunt trauma

penetrating trauma.

Question 2

pneumothorax symptoms

Answer 2

small, only mild tachycardia and dyspnea may be present

large pneumothorax, shallow, rapid respirations, dyspnea, air hunger, and oxygen desaturation

Chest pain and a cough with or without hemoptysis
No breath sounds detected upon auscultation over the affected area due to lack of air movement over the collapsed area
Chest x-ray shows air or fluid in the pleural space and reduction in lung volume

Question 3

Flail chest

symptoms, diagnosis

Answer 3

•The affected (flail) area moves in the opposite direction with respect to the intact portion of the chest. During inspiration, the affected portion is sucked in, and during expiration it bulges out.

Symptoms
• A flail chest is usually apparent on visual examination of the unconscious patient.
• rapid, shallow respirations, tachycardia, and moves air poorly. Movement of the thorax is asymmetric and uncoordinated.

Diagnosis
• Palpation of abnormal respiratory movements, evaluation for crepitus near the rib fractures, chest x-ray, and arterial blood gases (ABGs) all assist in the diagnosis.

Question 4

Emergency treatment of an open pneumothorax

Answer 4

covering the wound with an occlusive dressing that is secured on three sides (vent dressing).

During inspiration, as negative pressure is created in the chest, the dressing pulls against the wound, preventing air from entering the pleural space

Question 5

Treatment of Pneumothorax

Answer 5

1) nothing: appropriate for the stable patient
2) Chest tube connected to water-seal drainage: ny type of significant pneumothorax and hemothorax
3) Surgical repair: spontaneous pneumothorax
4) Needle decompression and chest tube insertion: tension pneumothorax is a medical emergency,

Question 6

Treatment of Flail Chest

Answer 6

initial therapy consists of airway management, mechanical ventilation, and supplemental oxygen therapy.

Careful administration of intravenous (IV) solution supports circulation.

Analgesia should be administered as needed.

Definitive therapy is to facilitate lung expansion and is chosen by the primary health care provider. Based on severity of the symptoms:

Intubation and ventilation may be necessary
Surgical fixation of the flail segment may be done
Lung parenchyma and fractured ribs will heal with time

Question 7

Chest tube

Answer 7

Chest tube malposition
Re-expansion pulmonary edema 
Vasovagal response with symptomatic hypotension
Infection at the skin site
Pneumonia
Shoulder disuse

Complications
• Routine milking or stripping of chest tubes to maintain patency is no longer recommended because it can cause dangerously high intrapleural pressure and damage to pleural tissue.
• Clamping of chest tubes during transport or when the tube is accidentally disconnected is no longer advocated; there is a danger of rapid accumulation of air in the pleural space, causing tension pneumothorax.

Question 8

Chest Tube removal

Answer 8

Removed when the lungs are re-expanded and fluid drainage has ceased
Suction is discontinued.
Gravity drainage