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Chest Trauma

Chest Trauma

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Published by Kring-kring Gerenia

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Published by: Kring-kring Gerenia on Jan 30, 2011
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01/28/2013

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L
CHESTTRAUMA
L
>>>Chesttraumainjuriesaredividedintotwocategories:PENETRATINGTRAUMAandBLUNTTRAUMA.
BluntTrauma-bluntforcetochestEx.automobilecrashesandfalls
 
PenetratingTrauma-projectilethatenterschestcausingsmallorlargeholeEx.Gunshotandstabbing
 
CompressionInjury-ChestiscaughtbetweentwoobjectsandchestiscompressedTypesofChestTrauma:
§
 
Ribfractures
§
 
Flailchest
§
 
Pulmonarycontusion
§
 
Pneumothorax
§
 
HaemothoraxRIBFRACTUREisabreakinaribbonecausedbyabluntchesttrauma(fall,blowtothechest,etc).
Ø
 
Symptoms

 
Contusionsandlacerations
 
Localizedpain
 
Tendernessoverthefracturedareaoninspirationandpalpation
 
Crepitusonthesofttissuearoundthefracturesite
 
Shallowrespiration,atelectasis&pneumonia
 
Painwhencoughing
 
Swellingandbruisinginthefracturearea
 
Internalbleeding
Ø
 
Diagnosed 
throughChestX-ray,CTandMRIforsofttissueinjury
Ø
 
Management
 
providerest,localheatandanalgesics,
asordered
 
ribbeltorbindermaybeused***
 
hospitalization(cannotmanagesecretions,abdominalinjuries,elderly,atelectasis,pneumonia)
 
surgicalproceduresincluderemovalofbonefragment(ribresection)andopenreduction-internalfixation(ORIF)FLAILCHESTisthebreakingof2ormoreribsin2ormoreplaces,resultinginfree-floatingribsegments.-Theflailsegmenthasnobonyorcartilaginousconnectionandmovesindependentlyofthechestwall
Ø
 
Symptoms

 
ShortnessofBreath
 
Multipleribfractures
 
Unstablechestwall
 
Pain
 
ParadoxicalMovement(abnormalchestmovementduringrespiration)
 
Crepitus(Grindingofboneendsonpalpation)
Ø
 
Complications
 
Hypoventilation
 
Atelectasis
 
Mediastinalflutter(mediastinalstructurestendtoswingbackandforth)
Ø
 
Diagnosed
throughpalpation,chestx-rayandABGanalysis
Ø
 
Management
dependsonthedegreeofrespiratorydistress
 
Localanestheticblockoftheaffectedribs
 
Iftheflailsegmentisimpairinggasexchangeorcontributingtohypoxemia,theflailsegmentshouldbesupportedbyafirmchestwraportemporarilybylayingthepatientwiththeflailsegmentdownagainstthetable.Thispreventstheflailsegmentfrommovingoutparadoxicallyduringexpiration
 
Oxygensupplementation
 
Mechanicalventilationforpersistentrespiratoryinsufficiency
 
PULMONARYCONTUSIONorlungcontusionisbruiseonthelung(damagetothelungtissues)resultinginhemorrhageandlocalizededema
Ø
 
Symptoms

 
Ecchymosisatthesiteofthedamage
 
Cracklesonauscultation
 
Coughwithblood-tingedsputum
 
Pulmonarycontusionstendtoworsenovera24–to48–hourperiodandthenslowlyresolveunlesscomplicationsoccur(infection,ARDS).
Ø
 
Management
 
Patientswithseverecontusionsmayrequireendotrachealintubationandmechanicalventilation
 
Frequentandpromptrespiratoryassessment
 
Adequateoxygenation
 
Analgesiatoimproveventilation
 
Clearingsecretion
 
Stabilizethethoraciccage
 
DeepbreathingexercisesPNEUMOTHORAXisapocketofairbetweenthetwolayersofpleura(parietalorvisceral),resultingincollapseofthelung.
OpenPneumothora
à
Airentersthepleuralspace,theaffectedlungbecomescompressed.Asthelungcollapses,thealveolibecomeunderventilated,causingV/Qmismatchingandintrapulmonaryshunting.Increasedpressurewithinthechestcanleadtoshiftingofthemediastinum,compressionofthegreatvessels,anddecreasedcardiacoutput
TensionPneumothorax
à
Occurswhenairisallowedtoenterthepleuralspacebutnotexitit;aspressureincreasesinsidethepleuralspace,thelungcollapsesandthemediastinumshiftstotheunaffectedside.
Ø
 
Symptoms

 
Anxiety/Restlessness
 
SevereDyspnea
 
AbsentBreathsoundsonaffectedside
 
Tachypnea
 
Tachycardia
 
AccessoryMuscleUse
 
TrachealDeviation(lateifseenatall)
Ø
 
Diagnosis
 
Percussionrevealshyperresonancewithdecreasedorabsentbreathsoundsovertheaffectedarea
 
ABGresultswilldemonstratehypoxemiaandhypercapnia
 
Achestx-rayfilmwillconfirmthepneumothorax
Ø
 
Management
 
Supplementaloxygenadministration,unlesscomplicationsoccurorunderlyinglungdiseaseorinjuryispresent.
 
interventiontoevacuatetheairfromthepleuralspaceandfacilitatereexpansionofthecollapsedlung(needledecompression)
 
Chesttubeinsertion
Ø
 
NursingManagement
 
Continuousandvigilantrespiratoryassessment
 
Optimizingoxygenationandventilation
 
Maintainingthechesttubesystem
 
Providingcomfortandemotionalsupport
 
ObserveforanycomplicationsHEMOTHORAXOccurswhenpleuralspacefillswithblood.Itusuallyoccursduetoalaceratedbloodvesselinthorax.Asbloodincreases,itputspressureonheartandothervesselsinchestcavity.
Ø
 
Symptoms

 
Anxiety/Restlessness
 
Tachypnea
 
SignsofShock
 
Frothy,BloodySputum
 
DiminishedBreathSoundsonAffectedSide
 
Tachycardia
 
Unequalrisingofthechest
Ø
 
Management

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