Chest Trauma

Question 1

The mechanisms of injuries causing chest trauma are separated into two categories:

Answer 1

blunt trauma and penetrating trauma.

Question 2

Blunt trauma

Answer 2

occurs when the chest strikes or is struck by an object. The impact can cause shearing and compression of thoracic structures.

Question 3

Penetrating trauma

Answer 3

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.

Question 4

Chest Trauma Etiology Blunt exs

Answer 4

• Motor vehicle accident • Pedestrian accident • Fall • Assault with blunt object • Crush injury • Explosion

Question 5

Chest Trauma Blunt and Penetrating Assessment Findings

Answer 5

• 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

Question 6

Chest Trauma Etiology Penetrating exs

Answer 6

• Knife • Gunshot • Stick • Arrow • Other missiles

Question 7

Pneumothorax

Answer 7

air entering the pleural cavity.

Question 8

Pneumothorax Manifestations

Answer 8

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.

Question 9

Pneumothorax and Hemothorax Intervention

Answer 9

Chest tube insertion with chest drainage system.

Question 10

Spontaneous Pneumothorax.

Answer 10

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.

Question 11

Iatrogenic Pneumothorax.

Answer 11

can occur due to laceration or puncture of the lung during medical procedures.

Question 12

Tension Pneumothorax.

Answer 12

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

Question 13

Hemothorax.

Answer 13

is an accumulation of blood in the pleural space resulting from injury to the chest wall, diaphragm, lung, blood vessels, or mediastinum.

Question 14

Hemothorax Manifestations

Answer 14

Dyspnea, diminished or absent breath sounds, dullness to percussion, decreased Hgb, shock depending on blood volume lost

Question 15

Tension Pneumothorax Manifestations

Answer 15

Cyanosis, air hunger, extreme agitation, tracheal deviation away from affected side, subcutaneous emphysema, neck vein distention, hyperresonance to percussion

Question 16

Tension Pneumothorax Intervention

Answer 16

Medical emergency: needle decompression followed by chest tube insertion with chest drainage system.

Question 17

Flail Chest

Answer 17

Fracture of two or more adjacent ribs in two or more places with loss of chest wall stability

Question 18

Flail Chest Manifestations

Answer 18

Paradoxical movement of chest wall, respiratory distress. May be associated hemothorax, pneumothorax, pulmonary contusion

Question 19

Flail Chest Intervention

Answer 19

O2 as needed to maintain O2 saturation, analgesia. Stabilize flail segment with positive pressure ventilation (intubation and mechanical ventilation). Treat associated injuries. Surgical fixation.

Question 20

Cardiac Tamponade

Answer 20

Blood rapidly collects in pericardial sac, compresses myocardium because pericardium does not stretch, and prevents ventricles from filling.

Question 21

Cardiac Tamponade Manifestations

Answer 21

Muffled, distant heart sounds, hypotension, neck vein distention, increased central venous pressure

Question 22

Pneumothorax can be classified as

Answer 22

open (air entering through an opening in the chest wall) or closed (no external wound).

Question 23

sucking chest wound

Answer 23

A penetrating chest wound. since air enters the pleural space through the chest wall during inspiration.

Question 24

Nursing care of a pneumothorax

Answer 24

covering the wound with an occlusive dressing that is secured on three sides (vent dressing).

Question 25

Rib fractures

Answer 25

are the most common type of chest injury resulting from blunt trauma.

Question 26

Clinical manifestations of fractured ribs

Answer 26

pain at the site of injury, especially during inspiration and with coughing. The patient splints the affected area and takes shallow breaths to try to decrease the pain. Atelectasis and pneumonia may develop because of decreased chest wall movement and retained secretions.

Question 27

Flail chest results from

Answer 27

the fracture of several consecutive ribs, in two or more separate places, causing an unstable segment. It can also be caused by fracture of the sternum and several consecutive ribs.