LUNG COMPRESSION

Oxygen Deprivation

Objectives

Describe complications of lung compression and chest trauma across life span

Describe clinical manifestationsApply nursing management principles and

measures

Chest trauma

Can occur alone or in combination

BluntPenetrating

Blunt Trauma

Sudden lung compression or positive pressure inflicted to chest wall.

Symptoms may be generalized or vague so difficult to identify

Patient may or may not seek immediate medical attention.

Diminished breath sounds

Common Causes

MVAFallsHitting the chestPatient being thrown into an object

Compression e.g. crush injury

Results

Hypovolemia from massive fluid lossHypoxemia from disruption of airwayCardiac failure Injuries are often life threateningImpaired ventilation and perfusion leading

to acute respiratory failureTime crucial when treating because of

location and possible injury to great blood vessels

Determine

Time since injury occurredLevel of responsivenessSpecific injuriesRecent drug or alcohol useMechanism of injuryEstimated blood lossAirway obstructionBreath sounds symmetry

Diagnostics

Chest x-rayCT scanCBCINR, PT, PTTType and cross matchPulse OxArterial blood gasesECG

Goals

Evaluate patients conditionInitiate aggressive resuscitationO2 supportPossible intubation and ventilator supportReestablish fluid volumeReestablish negative pleural pressure

Pneumothorax

Parietal or visceral pleura in breached and pleural space is exposed to positive atmospheric pressure

SimpleTraumaticTension

Simple

Air enters pleural space, lungs collapseRupture of a bleb (fluid filled sac)There is usually only partial collapse of a lungTrachea is midlineS/S include

Chest pain that can be dull, sharp, or stabbing. Pain starts suddenly and becomes worse with

coughing or deep breathing. Shortness of breath Tachypnea Cough.

Traumatic

Air escapes from lung lacerationCan occur during invasive procedures e.g.

biopsyOften accompanied by hemothoraxLung and structures of mediastinum (heart

and great vessels shift towards the uninjured side with each inspiration and the opposite way with expiration

Requires emergency intervention

Traumatic Signs and Symptoms

SOBAnxious patientTachypneaSucking sound heard because of the

rush of air through the wound in the chest wall e.g. sucking chest wounds

Tension

Air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest but does not leave, it gets trapped in the pleural space

Any condition that leads to pneumothorax can cause a tension pneumothorax

As the amount of trapped air increases, pressure builds up in the chest pushing the heart, major blood vessels, and airways toward the other side of the chest.

Trachea shifts away from the affected side. The shift can cause the other lung to become compressed, and can affect the flow of blood returning to the heart.

Tension Signs and Symptoms

Symptoms occur very suddenly and are very severe. The patient becomes extremely anxiousSOBChest tightness Easy fatigueBluish color of the skin due to lack of oxygen TachycardiaLow blood pressure Decreased mental alertness Decreased LOCTachypneaBulging (distended) veins in the neck

Hemothorax

Common cause chest traumaCollection of blood in the space between the chest

wall and the lung (the pleural cavity).S/S

Chest pain SOB Respiratory failure Tachycardia Anxiety and restlessness

Goals of Treatment

Stabilize the patientStop the bleedingRemove the blood and air in the pleural space

Pleural Effusion

Collection of fluid in the pleural space

Rarely a primary diseaseMay be complication of heart failure, pneumonia, TB, neoplasm, PE

Pathophysiology

Normally the pleural space contains a small amount of fluid which acts as lubricant

However with pleural effusion fluid is excessive.

Fluid types are:ClearBloodyPurulent

Clear

Can be transudate or an exudateTransudate are caused by systemic factors

that alter the balance of the formation and absorption of pleural fluid e.g. left ventricular failure, PE, cirrhosis

Exudate are caused by alterations in local factors that influence the formation and absorption of pleural fluid e.g. bacterial pneumonia, cancer, and viral infection

Signs and Symptoms

Many people have no symptomsThe most common symptoms, regardless of the

type of fluid in the pleural space or its cause, are: SOB Chest pain (pleuritic) felt only when the person

breathes deeply or coughs, or it may be felt continuously but may be worsened by deep breathing and coughing.

The pain is usually felt in the chest wall right over the site of the inflammation.

Management

Small pleural effusions may not require treatment, although the underlying disorder must be treated.

Larger pleural effusions, especially those that cause shortness of breath, may require drainage of the fluid (thoracentesis).

Usually, drainage dramatically relieves shortness of breath.

If effusion is related to malignancy it tends to recur within a few days or weeks.

Talc

Used to prevent malignant pleural effusion (buildup of fluid in the chest cavity in people who have cancer or other serious illnesses) in people who have already had this condition.

Talc is in a class of medications called sclerosing agents. It works by irritating the lining of the chest cavity so that the cavity closes and there is no space for fluid.

Nursing Care

Prepare and position patient for thoracentesis

Offer support through procedureNeed to make sure amount of fluid drained is

recorded and sent to lab for testingChest tube may also be inserted for larger

amounts of fluid to be removed.Evaluate pain levelAdminister analgesicsEducation re: care of chest tube

Empyema

Complication of bacterial pneumonia or lung abscess

Collection of pus in the cavity between the lung and the membrane that surrounds it (pleural space).

Puts pressure on lungsRisk factors include:PneumoniaLung abscessTraumaThoracic surgery

Signs and Symptoms

Similar to an acute respiratory infectionDry coughFebrile and chills Excess sweating, especially night sweats MalaiseWeight lossChest pain which worsens on deep inhalation

(inspiration) Decreased or absent breath sounds

Diagnostics

Chest x-rayThoracentesis Pleural fluid gram stain and culture CT scan of chestDrain pleural cavity to achieve full lung

expansion Thoracentesis Chest drainage tube Thoracotomy

Administer antibiotics

Nursing Management

Help patient cope with long process

Educate regarding lung expansion exercises

Depending on type of drainage, nurse supports patients

Flail Chest

Life threatening emergencyOccurs when a segment of the chest wall

breaks under extreme stress and becomes detached from the rest of the chest wall.

It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently.

Presentation

Inspiration: as chest expands, the detached part of the rib segment (flail segment) moves in a paradoxical manner. It is pulled inward during inspiration, reducing the amount of air that can be drawn into lungs.

Expiration: flail segment bulges outward impairing the patients ability to exhale. Mediastinum shifts back to affected side.

The constant motion of the ribs in the flail segment at the site of the fracture is incredibly painful, and, untreated, the sharp broken edges of the ribs are likely to eventually puncture the pleural sac and lung, possibly causing a pneumothorax

Management

Vent supportClear secretions from lungsControl painSevere flail requires endotrachial intubation

and mechanical ventilationCareful monitoring of chest x-ray, arterial

blood gases, pulse ox