Trauma respiratory 4a Flashcards
Chest Trauma
Flail chest •Rib fracture •Sternal fracture •Contusions (Pulmonary and cardiac) •Aortic injury •Pneumothorax
Pneumothorax
- Traumatic
- Spontaneous
- Tension
The mechanism of injuries causing chest trauma are separated into two
categories;
Blunt trauma
2. Penetrating trauma
Pneumothorax
•Caused by air entering the pleural cavity/space •As the volume of air in the pleural space increases, the volume of air in the lung decreases •Can cause partial or complete collapse of the lung
•Can be classified as
Pneumothorax
Primary spontaneous pneumothorax • Secondary pneumothorax • Iatrogenic (Traumatic) pneumothorax • Tension pneumothorax
Other types of ‘collections’ in the pleural
space
- Haemothorax
- Haemopneumothorax
- Chylothorax
- Pleural effusion
- Empyema
Diagnosis
Pneumothorax
- Comprehensive Patient History
- Physical assessment
- Chest X-ray/Ultrasound (except in tension pneumothorax)
•Haemothorax
signs
intervention
blood in pleural space may or may not occur in conjunction of pneumothorax
signs
dyspnoea, diminised of absent breath sounds, dullness of percussion, shock depending on blood loss
chest tube insertion with chest drainage autotransfussion of collected blood
Tension pneumothorax
air in pleral space does not escape. the increased air shift organ and increases inthoracic pressure
signs
cyanosis, air hunger, violent agitation, subcutaneuos emphysema, neck dissection
treatment
medical emergency, needle decompression followed by chest tube insertion, with chest drainage system
Flail chest
fracture of one or 2 adjacent ribs in 2 or more places with loos of chest wall ability
signs
paradoxical movement of chestwall, respiratory distress, ma be associated of haemothorax, pneumothorax, pulmonary contusion
treatment maintain o2 sat, analgesia, stabilise flail segment with positive pressure ventilation, treat associated surgeries, surgical fixation
Cardiac tamponade
Blood rapidly collects in preicardial sac, compresses myocardium, the pericardium does not stretch, and prevent ventriclesfrom filling
signs
muffled distant heart sounds, hypotension, neck vein distension, increased central venous pressure
treatment
medical emergency
pericardiocentsis with surgical repair as appropriate
Pneumothorax treatment/management
monitor respiratory status (oxygen if indicated, i.e. SpO2) •Administer pain relief •Depends on size and severity of pneumothorax and the underlying disease state of the patient and ranges from;
Pneumothorax treatment ranges
No treatment • Aspiration with a large bore needle • Insertion of an Under Water Seal Drain (UWSD) – chest drain is the most common treatment +/- low suction • Pleurodesis may be needed in some patients
Pre-insertion risk assessment
Ensure admitting consultant informed prior to insertion Check patient and correct site clinically and radiologically Obtain written consent (may waiver in emergency situation and critical care areas) Safe environment Underlying abnormal lung pathology Haemorrhage Infection Non invasive ventilation (NIV)
Nurses role in UWSD Insertion
•Ensure resuscitation trolley is available
•Gather and set up equipment
•Ensure blood test results available and be ready to correct any
coagulopathies or platelet defect
•Set up UWSD and ensure low suction available if ordered. UWSD
needs to be positioned at least 80cm below chest level
•Position (patient lying @45 degree with arm raised behind the
head or sitting and leaning forward) and support the patient
during procedure
•Administer analgesia/sedation as ordered
•Assist person inserting drain as required
•Ensure connections are secure and drain site anchored and
covered with appropriate dressing
•Chest x-ray ordered
•Monitor patients clinical status post insertion
•Monitor UWSD as per unit protocol
•Ensure accurate documentation of insertion by MO
