Unit 2: Chest Trauma Flashcards
2 Types of Chest Trauma
- blunt-force
- prenetrating trauma
Blunt Chest Trauma
the result of a blunt object hitting the chest or the chest striking a blunt surface such as the steering wheel
- can be further characterized as acceleration or deceleration injuries
- more diffuse than penetrating trauma
- may cause injuries that may not be obvious at the time of initial assessment
Deceleration Injuries
the movement of the body is suddenly stopped but the internal organs remain in motion and collide with the chest wall
-body has been moving and comes to an abrupt stop
Accelerated Injuries
- occurs when the body is abruptly set in motion (rear-end collisions) or when the body is hit by a rapidly moving object
- sudden increase in speed
Penetrating Trauma
the result of sharp objects (knives, bullets) entering the chest and causing damage to internal structures or organs
- other causes: objects that enter a motor vehicle during a collision (intrusion) or shrapnel from explosions
- the depth, angle, and location of the penetration can differentiate whether the penetrating trauma is a superficial wound or is potentially life-threatening
Common Injuries occurring as a result of Chest Trauma
- fractured ribs
- pneumothorax
- hemothorax
Common Injuries: Fractured ribs
most common injury associated w/ chest trauma
- the integrity of the entire thorax and chest wall movement are compromised
- patient cannot take deep, effective breaths, largely b/c of pain, effectively limiting the ability to maintain normal tidal volumes w/ each breath
- there may be collateral penetrating damage to the organs and vessels located near the site of injury (ex: liver)
A Flail Chest
three or more adjacent ribs that have been fractured in two or more places as a result of blunt or crush chest trauma, resulting in a “free” segment of the ribs
- “paradoxical” chest-wall movement is a hallmark sign
- with each inhalation the damaged area moves inward; on exhalation, this section of the chest wall moves outward
- chest wall movement is compromised largely b/c of pain; may result in respiratory insufficiency
Pneumothorax
the collection of air in the pleural space
- there is a reduction in the negative thoracic pressure because of the presence of air in the pleural space; makes inspiration more difficult, and the lung cannot adequately expand
- results in a reduction of gas exchange at the alveolar level, resulting in hypoxemia
Hemothorax
presence of blood in the pleural space
-occurs if there has been a laceration of the pulmonary vessel with blunt or penetrating trauma
-as blood fills the pleural space, the negative pressure is lost, limiting the lungs ability to expand
-the loss of blood from the vascular space mat result in hemodynamic compromise
>Drainage greater than 1500 mL = massive; may become hemodynamically unstable
Clinical Manifestations
- decreased oxygenation and ventilation
- gas exchange is compromised; decreased oxygenation
- initially, hyperventilation occurs in an effort to increase oxygen availability to the tissues, but eventually as the patient tires, CO2 will begin to rise
- Initial ABGs may = respiratory alkalosis d/t hyperventilation but respiratory acidosis will develop rapidly as CO2 is not exchanged
- early sign of hypoxemia is agitation and anxiety, then qa decreased LOC
- shortness of breath
- subcutaneous emphysema (air in the tissues under the skin) may occur with blunt trauma and pneumothorax
- pain; compromising chest wall expansion, thus oxygenation and ventilation
- exhibit splinting, assuming a protective posture around the site of injury; further compromises lung expansion on the side of injury and pneumonia may result
To Diagnose: Imaging Studies
- Chest x-ray
- Ultrasonography
- Chest CT
Chest X-Ray
to evaluate the skeletal features of the chest and to evaluate the integrity of the lungs
- x-ray is viewed to look for fractures, lung expansion, or mediastinal damage
- pneumothorax or hemothorax is visible on x-ray
Ultrasonography
focused assessment w/ sonography in trauma (FAST), is a valuable tool for a quick assessment in an emergency situation
-used to r/o cardiac tamponade (blood in the pericardium resulting in compression of the heart); life-threatening
Chest CT
performed upon a patient’s arrival to the ED in the case of high-impact thoracic trauma
-High-impact trauma: involves rapid deceleration and may result in chest wall deformities, multiple rib fractures, pneumothorax, or hemothorax
Laboratory Studies
- ABGs
- Serum lactate
- Hemoglobin/Hematocrit
- CBC and complete metabolic profile, coagulation studies, and a type and crossmatch in the event that the patient needs a blood transfusion
Laboratory Values: ABGs
arterial blood gases used to determine whether hypoxemia and abnormalities in the acid-base balance exist
-initially may indicate respiratory alkalosis d/t hyperventilation, but will quickly develop respiratory acidosis b/c of ineffective gas exchange and tiring
Laboratory Values: ABGs
arterial blood gases used to determine whether hypoxemia and abnormalities in the acid-base balance exist
-initially may indicate respiratory alkalosis d/t hyperventilation, but will quickly develop respiratory acidosis b/c of ineffective gas exchange and tiring
Laboratory Values: Serum Lactate Level
drawn to determine the adequacy of oxygen delivery to the tissues
-if the respiratory system is compromised, resulting in insufficient oxygen for cellular metabolism, anaerobic metabolism results
>this causes the production of lactic acids; rise in lactate levels within hours
Laboratory Values: Hemoglobin and Hematocrit
may be reduced if there is bleeding
-bleeding may be internal and not readily observable
Routine Labs Drawn in Any Trauma
- Electrolyte panels
- CBC
- Coagulation studies
- Patient specific tests
