Oxygen Deprivation

LUNG COMPRESSION
 Objectives

Describe complications of lung compression and

chest trauma across life span
Describe clinical manifestations
Apply nursing management principles and measures
 Chest trauma

Can occur alone or in combination

Blunt
Penetrating
 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

MVA
Falls
Hitting the chest
Patient being thrown into an object
Compression e.g. crush injury
 Results

Hypovolemia from massive fluid loss

Hypoxemia from disruption of airway
Cardiac failure
Injuries are often life threatening
Impaired ventilation and perfusion leading to
acute respiratory failure
Time crucial when treating because of location and
possible injury to great blood vessels
 Determine

Time since injury occurred

Level of responsiveness
Specific injuries
Recent drug or alcohol use
Mechanism of injury
Estimated blood loss
Airway obstruction
Breath sounds symmetry
 Diagnostics

Chest x-ray
CT scan
CBC
INR, PT, PTT
Type and cross match
Pulse Ox
Arterial blood gases
ECG
 Goals

Evaluate patients condition

Initiate aggressive resuscitation
O2 support
Possible intubation and ventilator support
Reestablish fluid volume
Reestablish negative pleural pressure
 Pneumothorax

Parietal or visceral pleura in breached and pleural

space is exposed to positive atmospheric pressure
Simple
Traumatic
Tension
 Simple

Air enters pleural space, lungs collapse

Rupture of a bleb (fluid filled sac)
There is usually only partial collapse of a lung
Trachea is midline
S/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 laceration

Can occur during invasive procedures e.g. biopsy
Often accompanied by hemothorax
Lung 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

SOB
Anxious patient
Tachypnea
Sucking 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 anxious
 SOB
 Chest tightness
 Easy fatigue
 Bluish color of the skin due to lack of oxygen
 Tachycardia
 Low blood pressure
 Decreased mental alertness
 Decreased LOC
 Tachypnea
 Bulging (distended) veins in the neck
 Hemothorax

 Common cause chest trauma

 Collection 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 patient

Stop the bleeding
Remove the blood and air in the
pleural space
 Pleural Effusion

Collection of fluid in the pleural space

Rarely a primary disease
May 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:
 Clear

 Bloody

 Purulent
 Clear

Can be transudate or an exudate

Transudate 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 symptoms

The 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 procedure
Need to make sure amount of fluid drained is
recorded and sent to lab for testing
Chest tube may also be inserted for larger amounts
of fluid to be removed.
Evaluate pain level
Administer analgesics
Education 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 lungs
Risk factors include:
Pneumonia
Lung abscess
Trauma
Thoracic surgery
 Signs and Symptoms

Similar to an acute respiratory infection

Dry cough
Febrile and chills
Excess sweating, especially night sweats
Malaise
Weight loss
Chest pain which worsens on deep inhalation
(inspiration)
Decreased or absent breath sounds
 Diagnostics

Chest x-ray
Thoracentesis
Pleural fluid gram stain and culture
CT scan of chest
Drain 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 emergency

Occurs 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 support
Clear secretions from lungs
Control pain
Severe flail requires endotrachial intubation and
mechanical ventilation
Careful monitoring of chest x-ray, arterial blood
gases, pulse ox