Unit 1: Chest Trauma Flashcards
A Pulmonary contusion, or a lung bruise, is basically a hemorrhage that results in _____ in and around the alveoli.
Edema
What happens to your breathing if you have increased fluid in and around the lungs?
Affects Ventilation!
Reduces both lung movement and available area for gas exchange
We can probably guess most of the S/S, but tell me when a patient might feel pain with a pulmonary contusion. During what?
Pain on inspiration
2 Tests to Diagnosis a Pulmonary contusion?
- CXR
- CT Scan
What can we do if the patient is having trouble breathing? (5)
- Apply oxygen
- Raise HOB
- Minimize anxiety
- Rest
- IV Fluids
What are the 3 scenarios that could develop into a deep chest injury?
- Injury to 1st and 2nd ribs
- Injury to >7 ribs
- Expired volume of air is <15 mmHg
What can rib fractures develop into?
Pulmonary contusion
Pneumothorax/Hemothorax
What’s our #1 priority r/t rib fractures? Why?
PAIN MANAGEMENT!
Want pt to take good, deep breaths
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??
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
When might you see flail chest out in the real world?
(aka what can cause this)
In the ED! (shew, wipe your brows, everyone)
Blunt chest trauma to one side
Following CPR
How do we diagnose flail chest?
- ABG
- CXR
What’s our main priority with flail chest?
(Think: what’s impaired by this)
Assess for worsening respiratory status / Increased O2 demand
- Gas exchange, coughing, & clearance of secretions is impaired
Besides the backward chest wall movement, What other S/S might we see with Flail chest? (6)
- Dyspnea
- Cyanosis
- Tachycardia
- Hypotension
- Pain
- Anxiety
Usually, Flail Chest is stabilized by…
Positive Pressure Ventilation
How do we want to position someone with Flail Chest? What could happen if we put them in High-Fowlers?
Good lung DOWN (opposite for pneumonia)
High-Fowlers could make them quickly go into SHOCK!
A pt with Flail Chest is gonna be wiggin’ out. What can we do to reduce anxiety?
Pain relief!!
Explain all procedures
Talk slowly
Allow time for expression of feelings + concerns
Nursing Interventions for flail chest: (4 + anxiety Mx)
- Oxygen (humidified)
- Pain Mx
- Pulmonary hygiene (deep breaths, cough)
- Aggressive Respiratory care
- tracheal suctioning if needed
What assessment findings would lead you to think a pneumothorax has developed? Is this an emergency?
→ 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
What causes a Closed (3) vs Open (1) pneumothorax?
Closed → COPD, mechanical ventilation, CVAD insertion
Open → trauma (Ex. stab wound)
If we suspect a pneumothorax, how do we diagnose it?
- CXR
- ABG
What’s the main treatment for a pneumothorax?
Chest tube
Other interventions for a pneumothorax (3)
- Pain Mx
- Oxygen support
- Pulmonary hygiene
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?!?!?!
TENSION pneumothorax! → CALL RAPID RESPONSE!
What will happen if a Tension pneumothorax is treated? (Patho)
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
What can cause Tension Pneumothorax? (4)
- Blunt force trauma
- Mechanical ventilation
- Chest tubes
- CVAD insertion
Treatment of Tension Pneumothorax (2)
- Needle Thoracostomy (large bore needle)
- Chest tube
What’s the nurse’s role r/t a Tension Pneumothorax? (5)
- Support patient
- CALL RAPID RESPONSE (Code Trauma)!
- Assist provider
- Monitor pt (frequent BP)
- Pain Mx
Where do we place a chest tube for a pneumothorax vs a hemothorax?
Pneumothorax → Upper lung
Hemothorax → Lower lung
What sounds would we hear during percussion of the lungs for a pneumothorax vs a hemothorax?
Pneumothorax → Hyperresonance
Hemothorax → Dull sound
The Interventions for a Hemothorax are similar to a Pneumothorax. What extra interventions should implement?
- Monitor & Record chest tube drainage
- IV fluids (we’d also do this for pneumo, but a hemothorax more likely to result in hypovolemic shock)
If you notice the chest tube drainage output is >50 mL/hr, what do??
Notify the Provider!
May need a blood transfusion
