Chest Trauma

Question 1

what is a pulmonary contusion?

Answer 1

lung bruise ! fluid accumulates and takes up space, painful , can lead to resp failure

Question 2

Pulmonary Contusion Assessment

Answer 2

• 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 !

Question 3

how is someone with a pulmonary contusion at risk for pneumonia?

Answer 3

• Shallow breathing (painful to breathe deep)- atelectasis–> pneumonia !

Question 4

how does someone with a pulmonary contusion have risk for dehydration and low CO2

Answer 4

Tachypnea- compensation- tire out, can’t do it for a long time –> can lead to low CO2 and dehydration

Question 5

diagnostics for pulmonary contusion?

Answer 5

chest x ray, CT scan

Question 6

nursing intreventions for pulm contusion

Answer 6

• 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

Question 7

typical cause of rib fracture?

Answer 7

blunt force to chest

Question 8

types of secondary injuries a rib fracture?

Answer 8

◦ Pneumothorax
◦ Hemothorax
◦ Pulmonary contusion

Question 9

rib fracture assessment and management

Answer 9

• 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)

Question 10

3 characteristics that define a deep chest injury from rib fracture?

Answer 10

• Injury to first and second ribs
• Injury to more than seven ribs
• Expired volume of air is <15ml/kg

• high mortality rate, likely intubated

Question 11

what is flail chest ? when does it occur?

Answer 11

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

Question 12

flail chest results in ______ air flow

Answer 12

reduced

Question 13

Are flail chest patients chill?

Answer 13

nah, they are in a lot of pain ant typically intubated

Question 14

flail chest assessment (hr? bp? breathing?)

Answer 14

• Paradoxical chest wall movement
• Anxiety & Pain
• Shortness of Breath
• Cyanosis
• Difficulty breathing
• Increased work of breathing
• Tachycardia
• Hypotension

Question 15

flail chest interventions

Answer 15

• Monitor vital signs, ABG’s
• Assess for worsening respiratory status/ increased O2 demand
• Oxygenate
• Pain Relief
• Pulmonary hygiene
• Aggressive Respiratory care
• Reduce anxiety

Question 16

pneumothorax vs tension pneumothorax

Answer 16

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

Question 17

pneumothorax assessment

Answer 17

• Tachypnea
• Subcutaneous emphysema
• Pain
• Diminished/ absent breath sounds on affected side
• Reduced movement of chest wall
• Increased O2 demand/ Shortness of breath

Question 18

diagnostics and management for pneumothorax

Answer 18

• 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

Question 19

how does a chest tube treat a pneumiothorax?

Answer 19

◦ Inserted through chest wall
◦ Suctions air from the pleura
◦ Creates negative pressure in pleura
◦ Lung reexpands

Question 20

causes of tension pneumothorax

Answer 20

• Blunt force trauma to chest –> regular pneumo can cause it
• Mechanical ventilation
• Chest tubes
• Central venous catheter insertion

Question 21

tension pneumothorax assessment

Answer 21

• 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)

Question 22

tension pneumo interventions

Answer 22

• 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

Question 23

bleeding into the pleura of lung =

Answer 23

hemothorax

Question 24

causes of hemothorax?

Answer 24

• liver failure/ renal failure/ heart failure at greatest risk for developing due to extra fluid

Question 25

hemothorax assessment

Answer 25

• Vary from no changes to severe
• Respiratory distress
• Diminished breath sounds

Question 26

hemothorax interventions

Answer 26

• 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

Question 27

if chest tube output is > ___ cc / hour report it to provider

Answer 27

> 50 cc = report!