Chest Trauma Flashcards
what is a pulmonary contusion?
lung bruise ! fluid accumulates and takes up space, painful , can lead to resp failure
Pulmonary Contusion Assessment
- Trauma to the chest
- Dyspnea
- Hypoxemic
- Decreased breath sounds
- Crackles
- Wheezes
- Cough
- Tachypnea- compensation- tire out, can’t do it for a long time –> can lead to low CO2 and dehydration
- Tachycardia- compensation
- Shortness of breath
- Pain (especially when breathing)
- Shallow breathing- atelectasis–> pneumonia !
how is someone with a pulmonary contusion at risk for pneumonia?
• Shallow breathing (painful to breathe deep)- atelectasis–> pneumonia !
how does someone with a pulmonary contusion have risk for dehydration and low CO2
Tachypnea- compensation- tire out, can’t do it for a long time –> can lead to low CO2 and dehydration
diagnostics for pulmonary contusion?
chest x ray, CT scan
nursing intreventions for pulm contusion
- Apply oxygen
- Bed position? - sitting up can hurt, spinal precautions can’t sit up, it depends!
- Minimize anxiety
- Rest
- IV Fluids needed
Monitor! can decline quickly
typical cause of rib fracture?
blunt force to chest
types of secondary injuries a rib fracture?
◦ Pneumothorax
◦ Hemothorax
◦ Pulmonary contusion
rib fracture assessment and management
• Pain –> pain medication, some need so much pain medication that they lose drive to breathe –> mechanically ventilate
• Splinting
• Shallow breathing
• If injury is uncomplicated: Relieve pain to optimize deep breathing (and avoid pneumonia and
atelectasis)
3 characteristics that define a deep chest injury from rib fracture?
- Injury to first and second ribs
- Injury to more than seven ribs
- Expired volume of air is <15ml/kg
• high mortality rate, likely intubated
what is flail chest ? when does it occur?
aradoxical chest wall movement caused by fractured ribs
◦ chest seeks in when you breathe not expand like normal
-occurs with toher injuries, 2 or > broken ribs that become free floating
flail chest results in ______ air flow
reduced
Are flail chest patients chill?
nah, they are in a lot of pain ant typically intubated
flail chest assessment (hr? bp? breathing?)
- Paradoxical chest wall movement
- Anxiety & Pain
- Shortness of Breath
- Cyanosis
- Difficulty breathing
- Increased work of breathing
- Tachycardia
- Hypotension
flail chest interventions
- Monitor vital signs, ABG’s
- Assess for worsening respiratory status/ increased O2 demand
- Oxygenate
- Pain Relief
- Pulmonary hygiene
- Aggressive Respiratory care
- Reduce anxiety
pneumothorax vs tension pneumothorax
Pneumothorax
• Air enters the pleural space
• Puts pressure on the lung –> lung collapses
Tension Pneumothorax
= Complete lung collapse involving air entering the lung without exit
• Air enters pleura during inhalation, does not exit during exhale
◦ Increased pressure in chest cavity, puts pressure on other side of chest/ other lung can collapse
◦ Decreased cardiac output, puts pressure on heart
◦ can result in complete hemodynamic collapse
pneumothorax assessment
- Tachypnea
- Subcutaneous emphysema
- Pain
- Diminished/ absent breath sounds on affected side
- Reduced movement of chest wall
- Increased O2 demand/ Shortness of breath
diagnostics and management for pneumothorax
• Chest x-ray • Treated with a chest tube ◦ Inserted through chest wall ◦ Suctions air from the pleura ◦ Creates negative pressure in pleura ◦ Lung reexpands • Pain management • Oxygen support --> increasing oxygen needs because not using part of their lungs • Pulmonary hygiene
how does a chest tube treat a pneumiothorax?
◦ Inserted through chest wall
◦ Suctions air from the pleura
◦ Creates negative pressure in pleura
◦ Lung reexpands
causes of tension pneumothorax
- Blunt force trauma to chest –> regular pneumo can cause it
- Mechanical ventilation
- Chest tubes
- Central venous catheter insertion
tension pneumothorax assessment
• Tracheal deviation (away from affected side) = hallmark finding of tension pneumothorax
◦ call a code!
◦ moves away from the side where the pneumo is –> all the pressure is pushing on the trachea
• Asymmetrical thorax
• Respiratory distress/ failure
• Distended neck veins
• Hypotension
• Tachycardia
• Confusion
• Decreased/absent breath sounds
• fluid is backing up and pressing on the heart, fluid can’t go anywhere
(everything but first 2 is same as cardiac tamponade)
tension pneumo interventions
• Needle Thoracostomy ◦ Large bore needle pokes through the pleural space not into lung • Chest tube placed after needle YOUR ROLE? • Support patient • Call for help • Assist provider • Monitor patient • Pain relief
bleeding into the pleura of lung =
hemothorax
causes of hemothorax?
• liver failure/ renal failure/ heart failure at greatest risk for developing due to extra fluid
hemothorax assessment
- Vary from no changes to severe
- Respiratory distress
- Diminished breath sounds
hemothorax interventions
• Chest tube insertion ◦ placed lower because fluid collects at the bottom, larger size than with pneumo which is collecting air • Monitor chest tube output • Notify MD when the output is > 50/hr • Pain relief • Pulmonary hygiene • IV fluids
if chest tube output is > ___ cc / hour report it to provider
> 50 cc = report!
