chest-trauma-final-1-1230874155399897-1

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WHAT IS IT?WHAT IS IT?

Chest trauma is often sudden Chest trauma is often sudden and dramaticand dramatic

Accounts for 25% of all Accounts for 25% of all trauma deathstrauma deaths

2/3 of deaths occur after2/3 of deaths occur after reaching hospitalreaching hospital


WHY DO IT OCCUR?WHY DO IT OCCUR?

Blunt TraumaBlunt Trauma- Blunt force to chest. E.g. - Blunt force to chest. E.g. automobile crashes and falls. automobile crashes and falls.

Penetrating TraumaPenetrating Trauma- Projectile that - Projectile that enters chest causing small or large hole. enters chest causing small or large hole. E.g. gun shot and stabbing.E.g. gun shot and stabbing.

Compression InjuryCompression Injury- Chest is caught - Chest is caught between two objects and chest is between two objects and chest is compressed.compressed.

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WHAT DOES IT DO?WHAT DOES IT DO?

Rib fractures Rib fractures

Flail chestFlail chest

Pulmonary contusion Pulmonary contusion Pneumothorax Pneumothorax HaemothoraxHaemothorax


Rib FractureRib Fracture

A rib fracture is a break in a rib bone.A rib fracture is a break in a rib bone. Cause is blunt chest trauma (fall, blow to the Cause is blunt chest trauma (fall, blow to the

chest, etc).chest, etc).SymptomsSymptoms Localized painLocalized pain Tenderness over the fractured area on Tenderness over the fractured area on

inspiration and palpationinspiration and palpation Shallow respiration atelectasis & pneumoniaShallow respiration atelectasis & pneumonia Pain when coughing Pain when coughing Swelling and bruising in the fracture area Swelling and bruising in the fracture area Internal bleedingInternal bleeding Pneumothorax or heamothorax Pneumothorax or heamothorax 04/08/2304/08/23

HOW TO DIAGNOSE?HOW TO DIAGNOSE?

CHEST XRAYCHEST XRAY


MANAGEMENT MANAGEMENT

Most rib fracture heals in 3 – 6 weeks.Most rib fracture heals in 3 – 6 weeks.Generally treated conservatively with Generally treated conservatively with

rest, local heat and analgesics.rest, local heat and analgesics.Monitor for the sign of associated injuries.Monitor for the sign of associated injuries.Rest and do not do physical activity.Rest and do not do physical activity.Adequate pain relief Adequate pain relief


FLIAL CHESTFLIAL CHEST

The breaking of The breaking of 2 or more ribs in 2 or more ribs in 2 or more 2 or more places, resulting places, resulting in free- floating in free- floating rib segments. rib segments.


The flail segment has no bony or The flail segment has no bony or cartilaginous connection cartilaginous connection Moves independently of the chest wallMoves independently of the chest wallParadoxical chest movementParadoxical chest movement


PARADOXICALPARADOXICAL

MOVEMENTMOVEMENT

The flail portion of the chest is • sucked in with inspiration, instead of expanding outward• Ballooned out with expiration instead of collapsing inward•Hypoventilation and hypoxemia

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S/S OF FLAIL CHESTS/S OF FLAIL CHEST

Shortness of BreathShortness of BreathParadoxical MovementParadoxical MovementBruising/SwellingBruising/SwellingCrepitus (Grinding of bone ends on Crepitus (Grinding of bone ends on

palpation)palpation)TachycardiaTachycardiaHypotension Hypotension


Complication:Complication:Hypoventilation Hypoventilation AtelectasisAtelectasisMediastinal flutter (mediastinal structures Mediastinal flutter (mediastinal structures

tend to swing back n forth)tend to swing back n forth)

Diagnosis:Diagnosis:Palpation : crepitus and tenderness near Palpation : crepitus and tenderness near

fractured ribs. fractured ribs. chest x-ray chest x-ray ABGs ABGs 04/08/2304/08/23 www.health-nurses-www.health-nurses-

doctors.blogspot.comdoctors.blogspot.com

PULMONARY CONTUSIONPULMONARY CONTUSION It is damage to the lung tissues resulting in It is damage to the lung tissues resulting in

hemorrhage and localized edema.hemorrhage and localized edema. Ecchymosis at the site of the damageEcchymosis at the site of the damage Crackels Crackels Cough may be present with blood-tinged Cough may be present with blood-tinged

sputum.sputum. Pulmonary contusions tend to worsen over Pulmonary contusions tend to worsen over

a 24– to 48–hour period and then slowly a 24– to 48–hour period and then slowly resolve unless complications occur resolve unless complications occur (infection, ARDS).(infection, ARDS).

Patients with severe contusions may Patients with severe contusions may require endotracheal intubation and require endotracheal intubation and mechanical ventilation mechanical ventilation

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NURSING IMPLICATIONNURSING IMPLICATION

NURSING DIAGNOSISNURSING DIAGNOSIS Ineffective Airway ClearanceIneffective Airway Clearance Ineffective Breathing PatternIneffective Breathing Pattern Impaired Gas ExchangeImpaired Gas Exchange PainPain Risk for InfectionRisk for Infection Activity IntoleranceActivity Intolerance AnxietyAnxiety Decreased Cardiac output Decreased Cardiac output Impaired tissue perfusionImpaired tissue perfusion Ineffective individual copingIneffective individual coping Altered health maintenanceAltered health maintenance



INTERVENTION:INTERVENTION:

Frequent and prompt Respiratory Frequent and prompt Respiratory assessmentassessment

Adequate oxygenationAdequate oxygenation Analgesia to improve ventilation.Analgesia to improve ventilation. Clearing secretionClearing secretion Stabilize the thoracic cage Stabilize the thoracic cage Deep breathing exercisesDeep breathing exercises Intubation and mechanical ventilation may Intubation and mechanical ventilation may

be required to prevent further hypoxiabe required to prevent further hypoxia04/08/2304/08/23 www.health-nurses-www.health-nurses-



Pain Control Pain Control Alternative to relieve pain:Alternative to relieve pain:

1.1. Intercostal Nerve Blocks Intercostal Nerve Blocks 2.2. Epidural Anesthesia.Epidural Anesthesia.3.3. Wearing a chest binderWearing a chest binder

Maintain IV flow ratesMaintain IV flow rates Monitor S/S of adequate tissue perfusionMonitor S/S of adequate tissue perfusion Anxiety reducing techniquesAnxiety reducing techniques Coping mechanismCoping mechanism Heath education/teachingHeath education/teaching04/08/2304/08/23 www.health-nurses-www.health-nurses-


COMPLICATIONS COMPLICATIONS PneumoniaPneumoniaARDSARDSLung abscessLung abscessEmphysemaEmphysemaPulmonary embolism. Pulmonary embolism.


PNEUMOTHORAXPNEUMOTHORAX

Pneumothorax is a pocket of air Pneumothorax is a pocket of air between the two layers of pleura between the two layers of pleura (parietal or visceral), resulting in (parietal or visceral), resulting in collapse of the lung. collapse of the lung.

TYPES :TYPES :Open PneumothoraxOpen PneumothoraxTension PneumothoraxTension Pneumothorax


TypesTypesOpen Laceration in the Open Laceration in the

parietal pleura that parietal pleura that allows atmospheric air allows atmospheric air to enter the pleural to enter the pleural space; occurs as a result space; occurs as a result of penetrating chest of penetrating chest traumatrauma

Closed Laceration in the Closed Laceration in the visceral pleura that visceral pleura that allows air from the lung allows air from the lung to enter the pleural to enter the pleural space; occurs as a result space; occurs as a result of blunt chest traumaof blunt chest trauma04/08/2304/08/23

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Open PneumothoraxOpen Pneumothorax


Open PneumothoraxOpen PneumothoraxInhale


Open PneumothoraxOpen PneumothoraxExhale


Open PneumothoraxOpen PneumothoraxInhale


Open PneumothoraxOpen PneumothoraxExhale


Open PneumothoarxOpen PneumothoarxInhale


Open PnuemothoraxOpen PnuemothoraxInhale


PathophysiologyPathophysiology Air enters the pleural space, the Air enters the pleural space, the

affected lung affected lung becomes becomes compressed. compressed.

As the lung collapses, the alveoli As the lung collapses, the alveoli become become underventilated, underventilated,

Causing V/Q mismatching and Causing V/Q mismatching and intrapulmonary intrapulmonary shunting. shunting.


CONT.. CONT..

If the pneumothorax is large, hypoxemia If the pneumothorax is large, hypoxemia ensues and acute respiratory failure ensues and acute respiratory failure quickly develops.quickly develops.

In addition, increased pressure within the In addition, increased pressure within the chest can lead to shifting of the chest can lead to shifting of the mediastinum, compression of the great mediastinum, compression of the great vessels, and decreased cardiac output vessels, and decreased cardiac output


Tension PneumothoraxTension Pneumothorax

Occurs when air is allowed Occurs when air is allowed to enter the pleural space to enter the pleural space but not exit it; as pressure but not exit it; as pressure increases inside the pleural increases inside the pleural space, the lung collapses space, the lung collapses and the mediastinum shifts and the mediastinum shifts to the unaffected side; may to the unaffected side; may be a result of a be a result of a spontaneous or traumatic spontaneous or traumatic pneumothorax.pneumothorax.


Tension PneumothoraxTension PneumothoraxEach time we inhale,

the lung collapses further. Thereis no place for the air to

escape..


Tension PneumothoraxTension Pneumothorax

Heart is beingcompressed

The trachea ispushed to

the good side


S/S OF TENSION S/S OF TENSION PNEUMOTHORAXPNEUMOTHORAX

Anxiety/RestlessnessAnxiety/Restlessness Severe DyspneaSevere Dyspnea Absent Breath Absent Breath

sounds on affected sounds on affected sideside

TachypneaTachypnea TachycardiaTachycardia Poor ColorPoor Color

Accessory Muscle Accessory Muscle UseUse

HypotensionHypotension Tracheal DeviationTracheal Deviation

(late if seen at all)(late if seen at all) Hyperresonance to Hyperresonance to

percussionpercussion

. .


Assessment and Assessment and DiagnosisDiagnosis

Depend on the degree of lung collapse. Depend on the degree of lung collapse. When a pneumothorax is large, decreased When a pneumothorax is large, decreased

respiratory excursion on the affected side may be respiratory excursion on the affected side may be noticed, along with bulging intercostal muscles. The noticed, along with bulging intercostal muscles. The trachea may deviate away from the affected side.trachea may deviate away from the affected side.

Percussion reveals hyperresonance with decreased Percussion reveals hyperresonance with decreased or absent breath sounds over the affected area.or absent breath sounds over the affected area.

ABGs will demonstrate hypoxemia and hypercapnia.ABGs will demonstrate hypoxemia and hypercapnia. A chest x-ray film will confirm the pneumothorax A chest x-ray film will confirm the pneumothorax

with increased translucency evident on the affected with increased translucency evident on the affected sideside


MEDICAL MANAGEMENTMEDICAL MANAGEMENTDepending on the severity of the Depending on the severity of the

specific disorder. specific disorder. At times requires only supplemental At times requires only supplemental

oxygen administration, unless oxygen administration, unless complications occur or underlying lung complications occur or underlying lung disease or injury is present.disease or injury is present.

At times urgently require intervention At times urgently require intervention to evacuate the air from the pleural to evacuate the air from the pleural space and facilitate re expansion of space and facilitate re expansion of the collapsed lung. the collapsed lung.


TreatmentTreatmentAdministering supplemental oxygen Administering supplemental oxygen Inserting a large-bore needle or catheter Inserting a large-bore needle or catheter

into the second intercostal space at the into the second intercostal space at the midclavicular line of the affected side. midclavicular line of the affected side. This action relieves the pressure within This action relieves the pressure within the chest. The needle should remain in the chest. The needle should remain in place until the patient is stabilized and a place until the patient is stabilized and a chest tube is insertedchest tube is inserted

Chest tube insertionChest tube insertion04/08/2304/08/23 www.health-nurses-www.health-nurses-


Needle DecompressionNeedle Decompression

Locate 2-3 Intercostal space midclavicular Locate 2-3 Intercostal space midclavicular lineline

Cleanse area using aseptic techniqueCleanse area using aseptic technique Insert catheter ( 14g or larger) at least 3” Insert catheter ( 14g or larger) at least 3”

in length over the top of the 3in length over the top of the 3rdrd rib( nerve, rib( nerve, artery, vein lie along bottom of rib)artery, vein lie along bottom of rib)

Remove Stylette and listen for rush of airRemove Stylette and listen for rush of air Place Flutter valve over catheterPlace Flutter valve over catheter Reassess for ImprovementReassess for Improvement


Needle DecompressionNeedle Decompression


Nursing DiagnosisNursing Diagnosis Impaired Gas Exchange related to ventilation/ Impaired Gas Exchange related to ventilation/

perfusion mismatching or intrapulmonary shunting perfusion mismatching or intrapulmonary shunting Ineffective Breathing Pattern related to decreased Ineffective Breathing Pattern related to decreased

lung expansion lung expansion Acute Pain related to transmission and perception of Acute Pain related to transmission and perception of

cutaneous, visceral, muscular, or ischemic impulsescutaneous, visceral, muscular, or ischemic impulses Anxiety related to threat to biologic, psychologic, Anxiety related to threat to biologic, psychologic,

and/or social integrityand/or social integrity Disturbed Body Image related to actual change in Disturbed Body Image related to actual change in

body structures, function, or appearancebody structures, function, or appearance Compromised Family Coping related to critically ill Compromised Family Coping related to critically ill

family memberfamily member04/08/2304/08/23 www.health-nurses-www.health-nurses-


NURSING INTERVENTIONSNURSING INTERVENTIONS

Continuous and vigilant respiratory Continuous and vigilant respiratory assessmentassessment

Optimizing oxygenation and Optimizing oxygenation and ventilation, ventilation,

Maintaining the chest tube systemMaintaining the chest tube system Providing comfort and emotional Providing comfort and emotional

supportsupport Maintaining surveillance for Maintaining surveillance for

complications.complications.04/08/2304/08/23 www.health-nurses-www.health-nurses-


HemothoraxHemothorax

Occurs when pleural space fills with Occurs when pleural space fills with bloodblood

Usually occurs due to lacerated blood Usually occurs due to lacerated blood vessel in thoraxvessel in thorax

As blood increases, it puts pressure As blood increases, it puts pressure on heart and other vessels in chest on heart and other vessels in chest cavitycavity

Each Lung can hold 1.5 liters of bloodEach Lung can hold 1.5 liters of blood



May put pressure on the heart04/08/2304/08/23

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Lots of blood vessels

Where does the blood come from.

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S/S of HemothoraxS/S of Hemothorax

Anxiety/RestlessnessAnxiety/RestlessnessTachypneaTachypneaSigns of ShockSigns of ShockFrothy, Bloody SputumFrothy, Bloody SputumDiminished Breath Sounds on Diminished Breath Sounds on

Affected SideAffected SideTachycardiaTachycardiaFlat Neck VeinsFlat Neck Veins04/08/2304/08/23 www.health-nurses-www.health-nurses-


Treatment for HemothoraxTreatment for Hemothorax

ABC’s ABC’s Secure Airway assist ventilation if Secure Airway assist ventilation if

necessary necessary General Shock Care due to Blood lossGeneral Shock Care due to Blood lossRAPID TRANSPORT to hospital.RAPID TRANSPORT to hospital.


SummarySummary

Chest Injuries are common and often life Chest Injuries are common and often life threatening in trauma patients. So, Rapid threatening in trauma patients. So, Rapid

identification and treatment of these identification and treatment of these patients is paramount to patient survival. patients is paramount to patient survival.

Airway management is very important and Airway management is very important and aggressive management is sometimes aggressive management is sometimes

needed for proper management of most needed for proper management of most chest injuries.chest injuries.


chest-trauma-final-1-1230874155399897-1

Documents

tension pneumothoraxeach

open pneumothorax

affected side

pleural space

lung collapses

needle decompression

complications

inhale