Unit 1: Chest Trauma

Question 1

A Pulmonary contusion, or a lung bruise, is basically a hemorrhage that results in _____ in and around the alveoli.

Answer 1

Edema

Question 2

What happens to your breathing if you have increased fluid in and around the lungs?

Answer 2

Affects Ventilation!
Reduces both lung movement and available area for gas exchange

Question 3

We can probably guess most of the S/S, but tell me when a patient might feel pain with a pulmonary contusion. During what?

Answer 3

Pain on inspiration

Question 4

2 Tests to Diagnosis a Pulmonary contusion?

Answer 4

1. CXR
2. CT Scan

Question 5

What can we do if the patient is having trouble breathing? (5)

Answer 5

1. Apply oxygen
2. Raise HOB
3. Minimize anxiety
4. Rest
5. IV Fluids

Question 6

What are the 3 scenarios that could develop into a deep chest injury?

Answer 6

1. Injury to 1st and 2nd ribs
2. Injury to >7 ribs
3. Expired volume of air is <15 mmHg

Question 7

What can rib fractures develop into?

Answer 7

Pulmonary contusion
Pneumothorax/Hemothorax

Question 8

What’s our #1 priority r/t rib fractures? Why?

Answer 8

PAIN MANAGEMENT!
Want pt to take good, deep breaths

Question 9

Upon assessment of your patient with several rib fractures, you see the chest isn’t moving in line with their respirations (aka paradoxical chest wall movement)… What the heck is happening and What do??

Answer 9

Flail chest! → CALL RAPID RESPONSE!
3 or more broken ribs become “free-floating” and move opposite to normal breathing (Inward movement on inspiration, outward movement on expiration); the mediastinum moves toward the unaffected lung

Question 10

When might you see flail chest out in the real world?
(aka what can cause this)

Answer 10

In the ED! (shew, wipe your brows, everyone)
Blunt chest trauma to one side
Following CPR

Question 11

How do we diagnose flail chest?

Answer 11

1. ABG
2. CXR

Question 12

What’s our main priority with flail chest?
(Think: what’s impaired by this)

Answer 12

Assess for worsening respiratory status / Increased O2 demand
- Gas exchange, coughing, & clearance of secretions is impaired

Question 13

Besides the backward chest wall movement, What other S/S might we see with Flail chest? (6)

Answer 13

1. Dyspnea
2. Cyanosis
3. Tachycardia
4. Hypotension
5. Pain
6. Anxiety

Question 14

Usually, Flail Chest is stabilized by…

Answer 14

Positive Pressure Ventilation

Question 15

How do we want to position someone with Flail Chest? What could happen if we put them in High-Fowlers?

Answer 15

Good lung DOWN (opposite for pneumonia)
High-Fowlers could make them quickly go into SHOCK!

Question 16

A pt with Flail Chest is gonna be wiggin’ out. What can we do to reduce anxiety?

Answer 16

Pain relief!!
Explain all procedures
Talk slowly
Allow time for expression of feelings + concerns

Question 17

Nursing Interventions for flail chest: (4 + anxiety Mx)

Answer 17

1. Oxygen (humidified)
2. Pain Mx
3. Pulmonary hygiene (deep breaths, cough)
4. Aggressive Respiratory care
   - tracheal suctioning if needed

Question 18

What assessment findings would lead you to think a pneumothorax has developed? Is this an emergency?

Answer 18

→ CALL RAPID RESPONSE!
1. Subcutaneous emphysema (rice crispies, yum)
2. Absent lung sounds on the affected side

Other findings: Tachypnea, Pain, reduced chest wall movement, dyspnea

Question 19

What causes a Closed (3) vs Open (1) pneumothorax?

Answer 19

Closed → COPD, mechanical ventilation, CVAD insertion
Open → trauma (Ex. stab wound)

Question 20

If we suspect a pneumothorax, how do we diagnose it?

Answer 20

1. CXR
2. ABG

Question 21

What’s the main treatment for a pneumothorax?

Answer 21

Chest tube

Question 22

Other interventions for a pneumothorax (3)

Answer 22

1. Pain Mx
2. Oxygen support
3. Pulmonary hygiene

Question 23

Your patient with a pneumothorax suddenly feels extremely short of breath and looks cyanotic. You then notice an asymmetrical thorax and tracheal deviation away from the affected lung.. What is happening?!?!?!

Answer 23

TENSION pneumothorax! → CALL RAPID RESPONSE!

Question 24

What will happen if a Tension pneumothorax is treated? (Patho)

Answer 24

Pulmonary AND Circulatory compromise
Air in the pleural space isn’t escaping on exhalation, which collapses the lung, compresses blood vessels, and limits blood return to the lung and then the heart

Decreased preload → decreased cardiac output → Hypotension → Obstructive SHOCK

Question 25

What can cause Tension Pneumothorax? (4)

Answer 25

1. Blunt force trauma
2. Mechanical ventilation
3. Chest tubes
4. CVAD insertion

Question 26

Treatment of Tension Pneumothorax (2)

Answer 26

1. Needle Thoracostomy (large bore needle)
2. Chest tube

Question 27

What’s the nurse’s role r/t a Tension Pneumothorax? (5)

Answer 27

1. Support patient
2. CALL RAPID RESPONSE (Code Trauma)!
3. Assist provider
4. Monitor pt (frequent BP)
5. Pain Mx

Question 28

Where do we place a chest tube for a pneumothorax vs a hemothorax?

Answer 28

Pneumothorax → Upper lung
Hemothorax → Lower lung

Question 29

What sounds would we hear during percussion of the lungs for a pneumothorax vs a hemothorax?

Answer 29

Pneumothorax → Hyperresonance
Hemothorax → Dull sound

Question 30

The Interventions for a Hemothorax are similar to a Pneumothorax. What extra interventions should implement?

Answer 30

1. Monitor & Record chest tube drainage
2. IV fluids (we’d also do this for pneumo, but a hemothorax more likely to result in hypovolemic shock)

Question 31

If you notice the chest tube drainage output is >50 mL/hr, what do??

Answer 31

Notify the Provider!
May need a blood transfusion