Chest Trauma Flashcards
What are the 5 types of chest trauma?
Blunt trauma
Penetrating Trauma
Pneumothorax
Fractured ribs
Flail Chest
What is blunt trauma?
Body struck by blunt object that causes an external injury that may appear minor but can mask life-threatening internal injuring
ie. trauma from steering wheel or bicycle, seat belt, and falls
What is penetrating trauma?
Foreign body impales body tissues
ie. gun shot wound
What is life-threatening about blunt trauma?
- Results in hypoxemia, hypovolemia, cardiac failure
- May lead to impaired ventilation, leading to hypovolemic shock and death
What is pneumothorax?
Presence of air in the pleural space
How does pneumothorax happen?
Occurs when the partial or visceral pleural is breached and the pleats disc is exposed to POSITIVE atmospheric pressure
air/blood/lymph in pleural space
What are the five types of pneumothorax?
- Closed
- Open
- Tension
- Hemothorax
- Chylothorax
What are the signs and symptoms of pneumothorax? (Small and large wounds)
small: mild tachycardia and dyspnea
large: respiratory distress, shallow, rapid respirations, dyspnea, air hunger, decrease o2 sat
** to know if it is a small wound or a large wound, chest x-rays are taken everyday
What is the treatment of pneumothorax?
- may resolve spontaneously
- aspiration of pleural space
- insertion of chest tube
What is closed pneumothorax?
also known as spontaneous/simple pneumothorax
- opening in lung tissue that leaks air into chest cavity
- occurs when air enters the pleural space through a rupture of a bleb or bronchopleural fistula
- USUALLY SELF CORRECTING
EXAMPLE: smoker, COPD
What is open pneumothorax?
“sucking” chest wound. Red bubbles on exhalation from wound
- air escapes from alteration in lung itself and enters the pleural space and/or through a wound in the chest wall
ex. stab wounds, gun shot, rib fractures
What is tension pneumothorax?
pressure with the pleural space is greater than atmospheric pressure resulting in the mediastinum displaced to one side interfering with breathing
- air than enters the chest cavity is trapped and cannot be expelled during expiration
- may be a complication from other types of pneumothorax, small hole in the chest wall, lung collapses
What are the signs and symptoms of tension pneumothorax?
MEDICAL EMERGENCY
- JVD, tracheal deviation, accessory muscle use
- severe dyspnea, poor colour, tachycardia, tachypnea
What is hemothorax?
accumulation of blood in the intrapleual space
What is the signs and symptoms of hemothorax?
- sudden pain
- tachypnea, hypotension, distended neck veins
- chest discomfort
- weak pulse, decreased breath sounds on the affected side
- may put pressure on the heart
- lung collapses = ARDs
What is the treatment for hemothorax?
- evacuate air or blood from pleural space
- chest tube to suction, high concentration of O2
- thoracotomy
What is a thoractomy?
decompression by inserting a large bore needle (14 F) 2nd intercostal space
What is the most common type of chest trauma and how?
Rib fracture from steering wheels causing pneumothorax
What would the nurse do if they found a pt with a rib fracture?
focus on:
- pain management
–> control pain = deeper breathing
- avoid excessive activity
avoid:
- taping, bandaging, splinting
DO NOT SPLINT THE CHEST, it decreases lung expansion
What is Chylothorax?
rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity
What is flail chest?
- one of the most critical chest injuries
- frequent complications of blunt trauma
- breaking of single rib in multiple spots resulting in chest wall losing stability and there is severe respiratory distress
- uneven lungs causes impaired gas exchange, more air coming in or leaving chest.
–> resulting in hypoxemia and respiratory acidosis
What age group is at most risk at getting flail chest? Why?
older adults: decreased rib agility, prone to falls and accidents
What are the signs and symptoms on flail chest?
dyspnea, cyanosis, tachycardia, hypotension, anxiety
What is the treatment of flail chest?
mechanical ventilation to achieve chest cavity stabilization
What is a pulmonary contusion?
Bruise to the lung caused by a chest injury
What are the signs and symptoms of a pulmonary contusion?
tachypnea, tachycardia, chest pain, blood tinged secretions, crackles, hypoxemia, respiratory acidosis, agitation
What is the treatment of pulmonary contusions?
if no disruption of parenchyma= self resolves
disruptions:
- iv therapy
- diuretics to reduce edema
What is a thoracentesis?
Procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest
What is pleurodesis?
Artificial production of adhesions between the parietal and viscera pleura using a chemical agent
–> bleomycin, tetracycline, talc powder
causes inflammation which tacks the two pleura together
What is the purpose of a chest tube?
TO drain fluid, air, or blood from the pleural space and to re-establish negative pressure that will facilitate the re-expansion of the lung
What are Kelly clamps?
Clamps chest tube to prevent positive atmosphere air to enter the lungs
Where is a chest tube location for a pt with pneumothorax?
2nd intercostal space
Where is a chest tube location for a pt with hemothorax?
4th-6th intercostal place
Are fluctuations in the water seal chamber normal? Why?
yes, fluid rises during inhalation and falls during exhalation when the to is breathing spontaneously
Is bubbling in the water seal chamber normal? Why?
No, bubbling should not be continuous. Document absence and presence of fluctuations
