Chest Trauma

Question 1

What are the 5 types of chest trauma?

Answer 1

Blunt trauma
Penetrating Trauma
Pneumothorax
Fractured ribs
Flail Chest

Question 2

What is blunt trauma?

Answer 2

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

Question 3

What is penetrating trauma?

Answer 3

Foreign body impales body tissues
ie. gun shot wound

Question 4

What is life-threatening about blunt trauma?

Answer 4

• Results in hypoxemia, hypovolemia, cardiac failure
• May lead to impaired ventilation, leading to hypovolemic shock and death

Question 5

What is pneumothorax?

Answer 5

Presence of air in the pleural space

Question 6

How does pneumothorax happen?

Answer 6

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

Question 7

What are the five types of pneumothorax?

Answer 7

1. Closed
2. Open
3. Tension
4. Hemothorax
5. Chylothorax

Question 8

What are the signs and symptoms of pneumothorax? (Small and large wounds)

Answer 8

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

Question 9

What is the treatment of pneumothorax?

Answer 9

• may resolve spontaneously
• aspiration of pleural space
• insertion of chest tube

Question 10

What is closed pneumothorax?

Answer 10

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

Question 11

What is open pneumothorax?

Answer 11

“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

Question 12

What is tension pneumothorax?

Answer 12

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

Question 13

What are the signs and symptoms of tension pneumothorax?

Answer 13

MEDICAL EMERGENCY
- JVD, tracheal deviation, accessory muscle use
- severe dyspnea, poor colour, tachycardia, tachypnea

Question 14

What is hemothorax?

Answer 14

accumulation of blood in the intrapleual space

Question 15

What is the signs and symptoms of hemothorax?

Answer 15

• 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

Question 16

What is the treatment for hemothorax?

Answer 16

• evacuate air or blood from pleural space
• chest tube to suction, high concentration of O2
• thoracotomy

Question 17

What is a thoractomy?

Answer 17

decompression by inserting a large bore needle (14 F) 2nd intercostal space

Question 18

What is the most common type of chest trauma and how?

Answer 18

Rib fracture from steering wheels causing pneumothorax

Question 19

What would the nurse do if they found a pt with a rib fracture?

Answer 19

focus on:
- pain management
–> control pain = deeper breathing
- avoid excessive activity
avoid:
- taping, bandaging, splinting
DO NOT SPLINT THE CHEST, it decreases lung expansion

Question 20

What is Chylothorax?

Answer 20

rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity

Question 21

What is flail chest?

Answer 21

• 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

Question 22

What age group is at most risk at getting flail chest? Why?

Answer 22

older adults: decreased rib agility, prone to falls and accidents

Question 23

What are the signs and symptoms on flail chest?

Answer 23

dyspnea, cyanosis, tachycardia, hypotension, anxiety

Question 24

What is the treatment of flail chest?

Answer 24

mechanical ventilation to achieve chest cavity stabilization

Question 25

What is a pulmonary contusion?

Answer 25

Bruise to the lung caused by a chest injury

Question 26

What are the signs and symptoms of a pulmonary contusion?

Answer 26

tachypnea, tachycardia, chest pain, blood tinged secretions, crackles, hypoxemia, respiratory acidosis, agitation

Question 27

What is the treatment of pulmonary contusions?

Answer 27

if no disruption of parenchyma= self resolves
disruptions:
- iv therapy
- diuretics to reduce edema

Question 28

What is a thoracentesis?

Answer 28

Procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest

Question 29

What is pleurodesis?

Answer 29

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

Question 30

What is the purpose of a chest tube?

Answer 30

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

Question 31

What are Kelly clamps?

Answer 31

Clamps chest tube to prevent positive atmosphere air to enter the lungs

Question 32

Where is a chest tube location for a pt with pneumothorax?

Answer 32

2nd intercostal space

Question 33

Where is a chest tube location for a pt with hemothorax?

Answer 33

4th-6th intercostal place

Question 34

Are fluctuations in the water seal chamber normal? Why?

Answer 34

yes, fluid rises during inhalation and falls during exhalation when the to is breathing spontaneously

Question 35

Is bubbling in the water seal chamber normal? Why?

Answer 35

No, bubbling should not be continuous. Document absence and presence of fluctuations