Chest Trauma

Question 1

Blunt trauma

Answer 1

• Body struck by blunt object
• External injury may appear
  minor but can mask lifethreatening internal injuries
  (e.g., ruptured spleen)
• Contrecoup trauma

Question 2

Penetrating trauma

Answer 2

• Foreign body impales or
  passes through the body
  tissues (e.g., gunshot wound,
  stabbing)

Question 3

PNEUMOTHORAX

Answer 3

Presence of air in the pleural space

Question 4

Types of pneumothorax

Answer 4

 Closed pneumothorax
 Open pneumothorax
 Tension pneumothorax
 Hemothorax
 Chylothorax

Question 5

TENSION PNEUMOTHORAX VS
HEMOTHORAX symptoms

Answer 5

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.

Question 6

ABGS IN PNEUMOTHORAX

Answer 6

Respiratory acidosis
 Low PH (<7.35)
 High PaCO2 (>40)

Question 7

Cm of a small Pneumothorax

Answer 7

mild tachycardia and dyspnea

Question 8

Cm of a large Pneumothorax

Answer 8

respiratory distress, including shallow, rapid respirations; dyspnea; air hunger;
decreased oxygen saturation

Question 9

Interprofessional care for PNEUMOTHORAX

Answer 9

 May resolve spontaneously
 Aspiration of pleural space
 Insertion of chest tube (water-seal drainage)

Question 10

Most common type of chest injury resulting from trauma

Answer 10

FRACTURED RIBS
 Ribs 5 through 10 are most commonly fractured because they are least protected by
chest muscles.

Question 11

Clinical manifestations of fractured ribs

Answer 11

 Pain (especially on inspiration) at the site of injury

Question 12

The main goal in treatment for fractured ribs

Answer 12

decrease pain so that the patient can
breathe adequately to promote good chest expansion

Question 13

What is a flail chest

Answer 13

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

Question 14

Interventions for flail chest

Answer 14

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.

Question 15

NURSING MANAGEMENT: CHEST DRAINAGE (2 things no longer recommended)

Answer 15

 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.

Question 16

CHEST TUBE COMPLICATIONS

Answer 16

Chest tube malposition
Re-expansion pulmonary edema
Vasovagal response with symptomatic hypotension
Infection at the skin site
Pneumonia
Shoulder disuse (“frozen shoulder”)

Question 17

when should CHEST TUBE REMOVAL occur

Answer 17

Removed when lungs are re-expanded and fluid
drainage has ceased
 Suction is discontinued gradually.
 Gravity drainage

Question 18

characterizations of RESTRICTIVE RESPIRATORY DISORDERS

Answer 18

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.

Question 19

Types of pleural effusions

Answer 19

 Transudative
 Exudative
Empyema: pleural effusion that contains pus

Can be determined from a sample of pleural fluid obtained via
thoracentesis

Question 20

Clinical manifestations of pleural effusion

Answer 20

 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

Question 21

clinical manifestations of Empyema

Answer 21

 Manifestations of empyema include those of pleural
effusion as well as fever, night sweats, cough, and weight
loss.

Question 22

Types of THORACENTESIS

Answer 22

 Diagnostic
 Therapeutic

Question 23

positing for a THORACENTESIS

Answer 23

The patient sits on the edge of a bed and leans forward over a
bedside table.

Question 24

How much fluid can be removed at one time? THORACENTESIS

Answer 24

1 000–1 200 mL of pleural fluid is removed at one time

Question 25

Why can’t you rapidly remove the needle? THORACENTESIS

Answer 25

Rapid removal can result in hypotension, hypoxemia, or pulmonary
edema.

Question 26

Pleurisy

Answer 26

 Inflammation of the pleura

Question 27

Atelectasis

Answer 27

 Condition of the lungs characterized by collapsed,
airless alveoli

Question 28

Types of RESTRICTIVE RESPIRATORY
DISORDERS

Answer 28

PLEURAL EFFUSION, Pleurisy, Atelectasis

Question 29

Role of Anesthesiologist in acute chest trauma

Answer 29

Assists with airway control and
establishing ventilation, provides anesthesia for surgical
procedures

Question 30

Role of Phlebotomist in acute chest trauma

Answer 30

: May draw blood and take specimens to
the laboratory

Question 31

Role of X-ray technician in acute chest trauma

Answer 31

Takes portable chest x-ray (CXR) films
and CT scans

Question 32

Role of Respiratory Therapist in acute chest trauma

Answer 32

: Manages the supportive respiratory
therapies and draws ABG samples

Question 33

Role of Social services or pastoral care staff in acute chest trauma

Answer 33

Acts as a crisis team for caregivers

Question 34

Role of Pharmacist in acute chest trauma

Answer 34

Serves as the drug cart manager

Question 35

Role of Nurse in acute chest trauma

Answer 35

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

Question 36

NURSING RESPONSIBILITIES IN FORENSIC EVIDENCE

Answer 36

• 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

Question 37

CULLEN SIGN

Answer 37

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