Chest Trauma Flashcards
The mechanisms of injuries causing chest trauma are separated into two categories:
blunt trauma and penetrating trauma.
Blunt trauma
occurs when the chest strikes or is struck by an object. The impact can cause shearing and compression of thoracic structures.
Penetrating trauma
is an injury in which a foreign object impales or passes through the body tissues, creating an open wound. Examples include knife wounds, gunshot wounds, and injuries with other sharp objects.
Chest Trauma Etiology Blunt exs
• Motor vehicle accident • Pedestrian accident • Fall • Assault with blunt object • Crush injury • Explosion
Chest Trauma Blunt and Penetrating Assessment Findings
• Dyspnea, respiratory distress • Cough with or without hemoptysis • Cyanosis of mouth, face, nail beds, mucous membranes• Rapid, thready pulse • Decreased BP • Narrowed pulse pressure • Asymmetric BP values in arms • Distended neck veins • Muffled heart sounds • Chest pain • Dysrhythmias• Open chest wound • Asymmetric chest movement
Chest Trauma Etiology Penetrating exs
• Knife • Gunshot • Stick • Arrow • Other missiles
Pneumothorax
air entering the pleural cavity.
Pneumothorax Manifestations
If a pneumothorax is small, mild tachycardia and dyspnea may be the only manifestations.
If the pneumothorax occupies a large area, respiratory distress may be present, including shallow, rapid respirations; dyspnea; air hunger; and O2 desaturation.
Pneumothorax and Hemothorax Intervention
Chest tube insertion with chest drainage system.
Spontaneous Pneumothorax.
occurs due to the rupture of small blebs (air-filled sacs) located on the surface of the lung. These blebs can occur in healthy, young individuals or as a result of lung disease such as COPD, asthma, cystic fibrosis, and pneumonia.
Iatrogenic Pneumothorax.
can occur due to laceration or puncture of the lung during medical procedures.
Tension Pneumothorax.
occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. This results in compression of the lung on the affected side and pressure on the heart and great vessels, pushing them away from the affected side
Hemothorax.
is an accumulation of blood in the pleural space resulting from injury to the chest wall, diaphragm, lung, blood vessels, or mediastinum.
Hemothorax Manifestations
Dyspnea, diminished or absent breath sounds, dullness to percussion, decreased Hgb, shock depending on blood volume lost
Tension Pneumothorax Manifestations
Cyanosis, air hunger, extreme agitation, tracheal deviation away from affected side, subcutaneous emphysema, neck vein distention, hyperresonance to percussion
Tension Pneumothorax Intervention
Medical emergency: needle decompression followed by chest tube insertion with chest drainage system.
Flail Chest
Fracture of two or more adjacent ribs in two or more places with loss of chest wall stability
Flail Chest Manifestations
Paradoxical movement of chest wall, respiratory distress. May be associated hemothorax, pneumothorax, pulmonary contusion
Flail Chest Intervention
O2 as needed to maintain O2 saturation, analgesia. Stabilize flail segment with positive pressure ventilation (intubation and mechanical ventilation). Treat associated injuries. Surgical fixation.
Cardiac Tamponade
Blood rapidly collects in pericardial sac, compresses myocardium because pericardium does not stretch, and prevents ventricles from filling.
Cardiac Tamponade Manifestations
Muffled, distant heart sounds, hypotension, neck vein distention, increased central venous pressure
Pneumothorax can be classified as
open (air entering through an opening in the chest wall) or closed (no external wound).
sucking chest wound
A penetrating chest wound. since air enters the pleural space through the chest wall during inspiration.
Nursing care of a pneumothorax
covering the wound with an occlusive dressing that is secured on three sides (vent dressing).
