Chest Trauma Flashcards
____ cavity is AIRTIGHT
thoracic.
(except for trachea- not air tight)
Air enters lungs via the ____.
trachea
3 Main causes of CHEST TRAUMA
- Blunt Trauma- Blunt force to chest - motor vehicle
- Penetrating Trauma- Projectile that enters chest causing small or large hole.
- Compression Injury- Chest is caught between two objects and chest is compressed.
Q: What is commonly OBSERVED during an assessment for CHEST TRAUMA?
- Cyanosis
- Bruises
- Lacerations
- Distended neck veins: Swollen veins in the neck that may indicate increased pressure in the chest.
- Tracheal deviation
- Subcutaneous emphysema: Air trapped under the skin, creating a crackling feeling when touched.
- Open chest wounds
- Lack of bilateral symmetry Uneven chest movement, which may indicate lung or rib issues.
- Paradoxical chest movement: part of the chest moves inward during inhalation instead of expanding, often due to broken ribs
RAPID ASSESSMENTS NEEDED FOR CHEST TRAUMA
Review:
Q: How does NEGATIVE pressure help us breathe?
- The pressure inside the chest (or lungs) is lower than the pressure outside the body.
- Negative pressure in the chest creates a vacuum effect.
- When the diaphragm moves downward and the chest expands, it lowers the pressure in the lungs compared to the outside air.
- This difference in pressure pulls air into the lungs for inhalation. During exhalation, the diaphragm relaxes, increasing pressure in the lungs and pushing air out.
SubQ Emphysema vs Edema
-
Subcutaneous Emphysema is AIR trapped under the skin, with a crackling feel
-bubble wrap feel when touched -
Edema is FLUID buildup, causing soft swelling.
-fells soft or puffy
Chest Trauma:
Q: What should be listened for in an AUSCULATATION assessment?
List 5
Key elements to listen for include:
- Presence or absence of breath sounds
- Location and loudness of HEART sounds: check for cardiac tamponade
- Volume of air inspired and expired
- Breathing rate and rhythm
- Symmetry of air movement on both sides
What should be assessed during palpation in a chest trauma assessment?
- Tenderness: Pain upon palpation indicates injury to bones, muscles, or soft tissues
- Bony Crepitus: A grating sensation when bones rub on each other suggesting fractured bones, typically ribs, which may cause internal injuries like pneumothorax.
- Subcutaneous Emphysema: A crackling sensation under the skin indicates air trapped in tissue
- Unstable Chest Wall Segment (Flail Chest): Multiple rib fractures that cause part of the chest wall to move independently
8 types of CHEST INJURIES
- Simple/Closed Pneumothorax
- Open Pneumothorax
- Tension Pneumothorax **
- Rib Fractures
- Flail Chest **
- Hemothorax
- Cardiac Tamponade
- Chylothorax
Out of the 8 types of chest injuries which 2 are EMERGENCIES?
- Tension Pneumothorax
- Flail Chest
These patients come FIRST!!!!
What is Simple/Closed Pneeumothorax
- Air enters the pleural space without an external wound, causing the lung to collapse
- Can lead to chest pain and difficulty breathing.
6 causes for CLOSED PNEUMOTHORAX
- Mechanical ventilation (Barotrauma)
- Insertion of subclavian catheter/pacemaker
- Perforation of Esophagus- from intubation (esophagus is very close to pleural space)
- Broken ribs
- Ruptured blebs: small, weakened areas of the lung (blebs) rupture
- Neonatal respiratory distress syndrome: Premature infants with underdeveloped lungs may experience air leaks due to weak lung structures, leading to pneumothorax.
Other 5 causes for Closed Pneumothorax
- Marfan Syndrome: connective tissue disorder that can cause lung rupture or air leakage, leading to a pneumothorax.
- COPD
- Emphysema
- CPR
- May be spontaneous
Treatement for Closed Pneumothorax
List 7
- Depends on size of pneumothorax and condition of patient
- Watchful waiting
- Needle venting: needle may be inserted into the pleural space to release trapped air & relieve pressure
- Thoracentesis
- Chest tube
- Chest physiotherapy (CPT): such as postural drainage or percussion, can help promote lung expansion & clear air from pleural space
- If small, TCDB and ambulation can help
What is OPEN PNEUMOTHORAX
- also known as a “sucking wound,
- occurs when there is an EXTERNAL wound in the chest wall, allowing air to enter and exit the pleural space, leading to lung collapse and impaired breathing.
8 S/S for OPEN PNEUMOTHORAX
- Asymmetrical chest movement: affected side showing reduced expansion due to lung collapse
- Possible sucking chest wound: An open wound allows air to be drawn in and out, creating a “sucking” sound as the patient breathes
- Tachypnea/dyspnea: due to lung collapse and reduced oxygen intake.
- Cough with possible hemoptysis
- Trachea/mediastinum may shift with insp/expiration: trachea and mediastinum may shift toward the unaffected side during inspiration and toward the affected side during expiration
- Decreased/absent breath sounds on affected side
- Restlessness /anxiety
- Chest pain: worsend by breathing
What is the mediastinum?
the central compartment of the thoracic cavity
* located between the lungs, containing vital structures such as the heart, great blood vessels, esophagus, trachea, and thymus
Treatment for OPEN PNEUMOTHORAX
- Seal wound: 3-sided occlusive dressing to cover the chest wound to prevent air from entering during inhalation while allowing air to escape during exhalation.
- Oxygen
- Monitor CARDIAC status: watch for cardiac tamponade, heart collapse
- Stabilize impaled object w/bulky dressing (do not remove)
- Thoracentesis / Chest tube and drainage
What is Tension Pneumothorax
- Air rapidly ACCUMULATES in the pleural space, creating pressure on the heart and great vessels
- Air can NOT ESCAPE from pleural space
- Causes life-threatening cardiovascular and respiratory compromise
- This is a MEDICAL EMERGENCY!!!- THESE PATIENTS COME FIRST!!!
S/S for Tension Pneumothorax
- Cyanosis
- Air hunger: sensation of not being able to breathe, leading to labored, rapid breathing **
- Violent agitation
- Tracheal deviation away from affected side
- Subcutaneous emphysema **
- Jugular vein distension -compression of superior vena cava **
Treatment for Tension Pneumothorax
- MEDICAL EMERGENCY! Call a code!
- Prepare for needle decompression, STAT
- O2 at 100%
- Possible intubation
- Chest tube insertion/thoracentesis
THESE PATIENTS COME FIRST!! KNOW THIS!!!
What is a Hemothorax?
- The accumulation of blood in the pleural space
- Often caused by trauma, cancer, side effects of anticoagulant medications, pulmonary embolism, or tearing of pulmonary adhesions.
- It is commonly found with an open pneumothorax, in which case it is referred to as a hemopneumothorax.
What is CHYLE
- Chyle is a milky, fatty fluid that is formed in the lymphatic system, primarily from the digestion of fats in the small intestine.
- It is transported through the lymphatic vessels and eventually enters the bloodstream, where it helps in the absorption of dietary fats and fat-soluble vitamins.
What is CHYLOTHORAX
- the accumulation of chyle (a milky, fatty fluid) in the pleural space
- typically due to damage or obstruction of the thoracic duct, which carries chyle from the intestines to the bloodstream.
- This condition can result from trauma, surgery, malignancy (cancer), or certain diseases
- May cause respiratory distress and fluid imbalance.
2 types of TRAUMA TO BONY STRUCTURES
- Rib fractures
- FLAIL CHEST- EMERGENCY!!
Trauma to Bony Structures:
Most common type of chest injury from trauma?
Rib Fractures are the most common type of chest injury from trauma, particularly involving ribs 5 through 10.
* Splintered or displaced fractures can damage the pleura and lungs, leading to complications like pneumothorax, hemothorax, or hemopneumothorax
5 S/S for RIB FRACTURES
- Mild to severe pain
- Sharp pain on INSPIRATION
- External bruising
- Bony crepitus: grating or crackling sensation felt when the fractured bone ends move against each other.
- Decreased/shallow respirations
Treatment for Rib Fractures
- Pain control-opioids but beware of resp. depression: avoid respiratory depression, especially in patients with compromised breathing.
- Splint with pillows: support the chest during coughing or deep breathing can help reduce pain and improve comfort.
- Intercostal nerve block: provides localized pain relief
- Cough/Deep breathing, use of incentive spirometer: prevents complications such as pneumonia, atelactasis & impaired ventilation due to pain experienced
Trauma to Bony Structures:
The breaking of 2 or more ribs in 2 or more places
FLAIL CHEST
- This results in paradoxical chest movement : opposite movement of chest during normal breathing.
- can lead to respiratory distress and compromised oxygenation
MEDICAL EMERGENCY- THESE PATIENTS COME FIRST!!!!!!1
5 S/s of Flail Chest
- Paradoxical chest movement
- Loss of chest wall rigidity
- Rapid, shallow respirations: Increased RR with shallow breaths due to pain & difficulty expanding the lungs.
- Ineffective respirations - resulting in hypoxemia: inability to take deep breaths effectively can lead to poor oxygenation (hypoxemia) as the lung can’t fully expand
- Results in pulmonary contusion and/or laceration: Flail chest can cause damage to the lung tissue (pulmonary contusion) or lacerations, which may lead to life-threatening complications like hemorrhage and impaired ventilation.
6 Treatments for Flail Chest
- Airway management - ABCs
- Stabilize flail segment: 1st, stabilize flail segment with hand, followed by using large pieces of tape applied horizontally across the flail segment to reduce movement & pain.
- Adequate ventilation
- Supplemental oxygen: prevent Hypoxemia
- Pain control
- Possible intubation/mechanical ventilation: in severe cases
In cases of trauma to the Great vessels or Heart, when femoral pulses are decreased or absent, which pulses are the last to be felt?
The CAROTID PULSES are the last to be felt
-they are closest to the heart and maintain perfusion to the brain as a priority.
Treatment for Trauma to Great Vessels & Heart
List 3
- Emergency surgical repair
- Pericardiocentesis: pericardium from heart drainage
- Mechanical ventilation
What is thoracentesis?
- Medical procedure in which a needle or catheter is inserted into the pleural space (the area between the lungs and the chest wall) to remove fluid or air.
- It is commonly performed to diagnose or treat conditions like pleural effusion, pneumonia, or a pneumothorax.
Nursing Care for Thoracentesis
List 7
- Vital Signs
- Assess Respiratory function
- Get consent signed
- Determine allergies
- Pre-medicate for pain, cough supplement if needed- PATIENT CAN NOT MOVE!!!
- Assess resp status, 02 sats, VS freq. for 1-2 hrs.
Most common complication of Thoracentesis
- Pneumothorax (Monitor: CXR, listen to breath sounds)
2 types of Disposable Chest Drainage Systems
- Wet Suction System
- “Waterless” or DRY suction system
Chest Drainage Systems have 3 BASIC compartments
- Collection chamber
- Water-seal chamber
- Suction control chamber
Compartment that receives fluid and air from chest cavity
- Collection Chamber
Compartment that acts as a one-way valve, prevents backflow of air into the client.
Water-seal chamber
Wet Suction System:
What does bubbling in the water-seal chamber indicate?
- Air Leak: If there is an ongoing air leak from the pleural space or from the chest tube insertion site, bubbles will be visible in the water-seal chamber. This may indicate that air is continuing to escape into the drainage system, which requires further monitoring or intervention. - NOT GOOD!
Compartment that typically is filled with 20 cm of water and connected to wall suction
Suction control chamber
Water Suction System:
What does bubbling in the SUCTION CONTROL CHAMBER indicate?
know
- Bubbling in the suction control chamber is a NORMAL FINDING when the chest drainage system is connected to wall suction.
- This chamber regulates the amount of suction applied to the system.
- Bubbling occurs when the system is actively draining air or fluid from the pleural space, and it helps indicate that the suction is functioning properly.
- If bubbling stops and there is no suction, it could suggest a malfunction in the system, such as a disconnect in the tubing or an issue with the wall suction source, requiring investigation.
YOU WANT GENTLE BUBBLING HERE
Chest Drainage:
What is a “WaterLESS” or Dry Suction System?
- A mechanical one-way valve prevents air from re-entering the pleural space, ensuring air or fluid drains out safely.
- Suction is controlled by a dial on the unit, allowing precise regulation of suction pressure.
- May have a water-filled air leak indicator that detects air leaks by showing bubbles if there is air escaping from the pleural space- NOT GOOD!!! - KNOW!!!!
What do these bubbles indicate on BOTH Water and Dry Drainage Systems?
- These bubbles are NOT A GOOD THING.
- Potential leak somewhere- need to fix!!
What should be done if the chest tube or drainage tubing becomes DISCONNECTED?
2 steps to do
-
Submerge the chest tube in 2-3 inches of sterile saline or sterile water.
-This creates a temporary seal and prevents air from entering the pleural space, reduces risk of a tension pneumothorax and other complications from air re-entering the pleural cavity.
-END of tube should touch the bottom of bottle - Tape all new connections to ensure a secure and airtight seal when setting up a new drainage system.
