Penetrating Chest Trauma

Question 1

What is the pathophysiology of Hemothorax/Pneumotherax ?

Answer 1

Blood or air has accumulated in the pleural space

Question 2

What has happened to the lung in Hemotherax/Pneumotherax ?

Answer 2

It has collapsed

Question 3

What are signs & symptoms of Hemothorax/Pneumothorax ?

Answer 3

• SOB
• Increased HR
• Diminished breath sounds on the affected side
• Less movement on the affected side
• Chest pain
• Cough

Question 4

What will show up on the X-ray in a client with either a Hemothorax/Pneumothorax ?

Answer 4

Hemothorax = Blood (Hem)
Pneumothorax = Air (pneumo)

Question 5

What is Subcutaneos emphysema ?

Answer 5

Air trapped in the tissue (usually neck, face, and chest)

• feels like rice crispies (crepitus)

Question 6

What is the Tx for Hemotherax/Pneumothorax ?

Answer 6

• Thoracentesis
• Chest tube
• Daily chest x-ray

Question 7

What is the Pathophysiology of Tension Pneumothorax ?

Answer 7

Pressure has built up in the chest/pleural space and has collapsed the lung

(pressure pushes everything to the opposite side - medicinal shift)

Question 8

What does Tension Pneumothorax cause ?

Answer 8

Mediastinal shift

Question 9

If the trachea is deviated due to mediastinal shift, what is it ?

Answer 9

An Emergency!

Question 10

What are the causes of Tension Pneumothorax ?

Answer 10

• Trauma
• Too much PEEP (ventilator settings)
• Clamping a chest tube
• Inserting central venous lines
• Taping an open pneumothorax on all 4 sides without an air valve

Question 11

What are signs and symptoms of a Tension Pneumothorax ?

Answer 11

• Subcutaneous emphysema
• Absence of breath sounds on one side
• Asymmetry of thorax
• Respiratory distress
• Cyanosis
• Distended neck veins, or JVD

Question 12

Tension pneumothorax can be what ? and why ?

Answer 12

Fatal

as accumulating pressure compresses vessels –> decreases venous return –> decreases cardiac output

Question 13

What is the Tx for Tension Pneumothorax ?

Answer 13

• Large bore needle is placed into the 2nd intercostal space (by the PCP) to allow excess air to escape
• Treat the cause (chest tubes will be inserted)

Question 14

Open pneumothorax is also known as what ?

Answer 14

Sucking chest wound

Question 15

What is the Pathophysiology of an Open Pneumothorax (sucking chest wound) ?

Answer 15

Opening through the chest that allows air into the pleural space

Question 16

What is the Treatment for Open Pneumothorax (sucking chest wound) ?

Answer 16

• Have the client inhale and hold or Valsalva or hummmmm
• Then, place the a piece of petroleum gauze over the area
• Have the client sit up (if possible) to expand lungs
  (trauma clients stay flat, until evaluated for other injuries)

Question 17

In clients with an Open pneumothorax, why do you want them to inhale and hold or valsalva or hummmmm ?

Answer 17

These will increase the intra-thoracic pressure so no more outside air can get into the body

Question 18

In a client with an Open pneumothorax, how many sides should you tape down & why when placing a piece of petroleum gauze over the area ?

Answer 18

3 sides

Because the fourth side acts like an air vent or flutter valve