Chest Trauma Flashcards
Blunt trauma
- Body struck by blunt object
- External injury may appear
minor but can mask lifethreatening internal injuries
(e.g., ruptured spleen) - Contrecoup trauma
Penetrating trauma
- Foreign body impales or
passes through the body
tissues (e.g., gunshot wound,
stabbing)
PNEUMOTHORAX
Presence of air in the pleural space
Types of pneumothorax
Closed pneumothorax
Open pneumothorax
Tension pneumothorax
Hemothorax
Chylothorax
TENSION PNEUMOTHORAX VS
HEMOTHORAX symptoms
Tension Pneumothorax
Neck vein distention ,Tracheal deviation away from the affected side ,Subcutaneous emphysema
Hemothorax
Signs of shock, Decreased hemoglobin
Both
Tachycardia, Decreased or absent breath sounds, Dyspnea, Increased respiratory rate.
ABGS IN PNEUMOTHORAX
Respiratory acidosis
Low PH (<7.35)
High PaCO2 (>40)
Cm of a small Pneumothorax
mild tachycardia and dyspnea
Cm of a large Pneumothorax
respiratory distress, including shallow, rapid respirations; dyspnea; air hunger;
decreased oxygen saturation
Interprofessional care for PNEUMOTHORAX
May resolve spontaneously
Aspiration of pleural space
Insertion of chest tube (water-seal drainage)
Most common type of chest injury resulting from trauma
FRACTURED RIBS
Ribs 5 through 10 are most commonly fractured because they are least protected by
chest muscles.
Clinical manifestations of fractured ribs
Pain (especially on inspiration) at the site of injury
The main goal in treatment for fractured ribs
decrease pain so that the patient can
breathe adequately to promote good chest expansion
What is a flail chest
Results from multiple rib fractures, causing instability of the
chest wall
The affected (flail) area will move paradoxically to the
intact portion of the chest during respiration; during
inspiration, the affected portion is sucked in, and during
expiration, it bulges out.
Prevents adequate ventilation of the lung in the injured
area
Interventions for flail chest
Initial therapy consists of adequate ventilation, administration of
humidified O2
, administration of crystalloid IV solutions, and pain
control.
Definitive therapy is to re-expand the lung and ensure adequate
oxygenation.
NURSING MANAGEMENT: CHEST DRAINAGE (2 things no longer recommended)
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.
CHEST TUBE COMPLICATIONS
Chest tube malposition
Re-expansion pulmonary edema
Vasovagal response with symptomatic hypotension
Infection at the skin site
Pneumonia
Shoulder disuse (“frozen shoulder”)
when should CHEST TUBE REMOVAL occur
Removed when lungs are re-expanded and fluid
drainage has ceased
Suction is discontinued gradually.
Gravity drainage
characterizations of RESTRICTIVE RESPIRATORY DISORDERS
Characterized by a restriction in lung volume, caused by decreased
compliance of the lungs or chest wall
Extrapulmonary disorders involve the central nervous system,
neuromuscular system, and chest wall.
Intrapulmonary disorders involve the pleura or the lung tissue.
Types of pleural effusions
Transudative
Exudative
Empyema: pleural effusion that contains pus
Can be determined from a sample of pleural fluid obtained via
thoracentesis
Clinical manifestations of pleural effusion
Progressive dyspnea; decreased movement of the chest
wall on the affected side; pleuritic pain from the
underlying disease; dullness to percussion and absent or
decreased breath sounds over the affected area during
physical examination
clinical manifestations of Empyema
Manifestations of empyema include those of pleural
effusion as well as fever, night sweats, cough, and weight
loss.
Types of THORACENTESIS
Diagnostic
Therapeutic
positing for a THORACENTESIS
The patient sits on the edge of a bed and leans forward over a
bedside table.
How much fluid can be removed at one time? THORACENTESIS
1 000–1 200 mL of pleural fluid is removed at one time
Why can’t you rapidly remove the needle? THORACENTESIS
Rapid removal can result in hypotension, hypoxemia, or pulmonary
edema.
Pleurisy
Inflammation of the pleura
Atelectasis
Condition of the lungs characterized by collapsed,
airless alveoli
Types of RESTRICTIVE RESPIRATORY
DISORDERS
PLEURAL EFFUSION, Pleurisy, Atelectasis
Role of Anesthesiologist in acute chest trauma
Assists with airway control and
establishing ventilation, provides anesthesia for surgical
procedures
Role of Phlebotomist in acute chest trauma
: May draw blood and take specimens to
the laboratory
Role of X-ray technician in acute chest trauma
Takes portable chest x-ray (CXR) films
and CT scans
Role of Respiratory Therapist in acute chest trauma
: Manages the supportive respiratory
therapies and draws ABG samples
Role of Social services or pastoral care staff in acute chest trauma
Acts as a crisis team for caregivers
Role of Pharmacist in acute chest trauma
Serves as the drug cart manager
Role of Nurse in acute chest trauma
perform an initial assessment, monitor VS, make
certain all ordered procedures are carried out, administer
medications, place Foley catheter and NG tube, hang IV
fluids and blood, help with chest tube insertion and
bedside procedures, accompany the patient to diagnostic
testing procedures, and precisely document all patient
care
NURSING RESPONSIBILITIES IN FORENSIC EVIDENCE
- If clothing must be removed, do not cut through a
gunshot hole. Cut along seam lines as far away
from the evidence as possible. Place each garment
in a separate brown paper bag, touching and
disturbing as little as possible. Avoid contaminating
evidence; wear appropriate protective equipment,
handle as little as possible, and avoid sneezing
and/or coughing over samples. Keep accurate,
unbiased documentation. Include the location of
the injuries. - Diagrams and photography are helpful. Note any
patient statements about the incident. Leave the
patient’s skin unwashed until documentation and
collection of evidence is complete
CULLEN SIGN
Cullen’s sign refers to a medical indication of a potential serious underlying condition. Specifically, it is a superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus (belly button). This sign can be associated with various medical conditions, and its presence may suggest internal bleeding or other abdominal issues
