L

 CHEST  TRAUMA  L   ◊ hospitalization   (cannot   manage  

secretions,   abdominal   injuries,   elderly,  
>>>Chest   trauma   injuries   are   divided   into   two   atelectasis,  pneumonia)  
categories:   PENETRATING   TRAUMA   and   BLUNT   ◊ surgical   procedures   include   removal   of  
TRAUMA.     bone   fragment   (rib   resection)   and   open  
reduction-­‐internal  fixation  (ORIF)  
◘  Blunt  Trauma-­‐  blunt  force  to  chest    
Ex.  automobile  crashes  and  falls     FLAIL  CHEST  is  the  breaking  of  2  or  more  ribs  in  
  2   or   more   places,   resulting   in   free-­‐   floating   rib  
◘ Penetrating   Trauma-­‐   projectile   that   enters   segments.    
chest  causing  small  or  large  hole   -­‐     The   flail   segment   has   no   bony   or  
Ex.    Gun  shot  and  stabbing   cartilaginous   connection   and   moves  
  independently  of  the  chest  wall  
◘ Compression   Injury-­‐   Chest   is   caught   between   Ø Symptoms    
two  objects  and  chest  is  compressed   ◊ Shortness  of  Breath  
  ◊ Multiple  rib  fractures  
Types  of  Chest  Trauma:   ◊ Unstable  chest  wall  
§ Rib  fractures           ◊ Pain  
§ Flail  chest   ◊ Paradoxical   Movement   (abnormal   chest  
§ Pulmonary  contusion     movement  during  respiration)  
§ Pneumothorax    
◊ Crepitus   (Grinding   of   bone   ends   on  
§ Haemothorax  
palpation)  
 
Ø Complications  
RIB  FRACTURE  is  a  break  in  a  rib  bone  caused  by  
◊ Hypoventilation    
a   blunt   chest   trauma   (fall,   blow   to   the   chest,  
◊ Atelectasis  
etc).  
◊ Mediastinal   flutter   (mediastinal  
Ø Symptoms    
structures  tend  to  swing  back  and  forth)  
◊ Contusions  and  lacerations  
Ø Diagnosed   through   palpation,   chest   x-­‐
◊ Localized  pain  
ray  and  ABG  analysis  
◊ Tenderness   over   the   fractured   area   on  
Ø Management   depends   on   the   degree   of  
inspiration  and  palpation  
respiratory  distress  
◊ Crepitus   on   the   soft   tissue   around   the  
◊ Local   anesthetic   block   of   the   affected  
fracture  site  
ribs  
◊ Shallow   respiration,   atelectasis   &  
◊ If   the   flail   segment   is   impairing   gas  
pneumonia  
exchange   or   contributing   to   hypoxemia,  
◊ Pain  when  coughing     the  flail  segment  should  be  supported  by  
◊ Swelling  and  bruising  in  the  fracture  area     a   firm   chest   wrap   or   temporarily   by  
◊ Internal  bleeding   laying   the   patient   with   the   flail   segment  
Ø Diagnosed   through   Chest   X-­‐ray,   CT   and   down  against  the  table.  This  prevents  the  
MRI  for  soft  tissue  injury   flail   segment   from   moving   out  
Ø Management   paradoxically  during  expiration  
◊ provide   rest,   local   heat   and   analgesics,   ◊ Oxygen  supplementation  
as  ordered   ◊ Mechanical   ventilation   for   persistent  
◊ rib  belt  or  binder  may  be  used  ***   respiratory  insufficiency    
 
PULMONARY   CONTUSION   or   lung   contusion   is   ◊ Tachycardia  
bruise  on  the  lung  (damage  to  the  lung  tissues)   ◊ Accessory  Muscle  Use  
resulting  in  hemorrhage  and  localized  edema   ◊ Tracheal  Deviation(late  if  seen  at  all)  
Ø Symptoms     Ø Diagnosis  
◊ Ecchymosis  at  the  site  of  the  damage   ◊ Percussion   reveals   hyperresonance   with  
◊ Crackles  on  auscultation   decreased  or  absent  breath  sounds  over  
◊ Cough  with  blood-­‐tinged  sputum   the  affected  area  
◊ Pulmonary   contusions   tend   to   worsen   ◊ ABG  results  will  demonstrate  hypoxemia  
over   a   24–   to   48–hour   period   and   then   and  hypercapnia  
slowly   resolve   unless   complications   ◊ A   chest   x-­‐ray   film   will   confirm   the  
occur  (infection,  ARDS).   pneumothorax    
Ø Management   Ø Management  
◊ Patients   with   severe   contusions   may     ◊ Supplemental   oxygen   administration,  
require   endotracheal   intubation   and   unless   complications   occur   or  
mechanical  ventilation     underlying   lung   disease   or   injury   is  
◊ Frequent   and   prompt   respiratory   present.  
assessment   ◊ intervention   to   evacuate   the   air   from  
◊ Adequate  oxygenation   the   pleural   space   and   facilitate   re  
◊ Analgesia  to  improve  ventilation   expansion   of   the   collapsed   lung  
◊ Clearing  secretion   (needle  decompression)  
◊ Stabilize  the  thoracic  cage     ◊ Chest  tube  insertion  
◊ Deep  breathing  exercises   Ø Nursing  Management  
  ◊ Continuous   and   vigilant   respiratory  
PNEUMOTHORAX  is  a  pocket  of  air  between   assessment  
the  two  layers  of  pleura  (parietal  or  visceral),   ◊ Optimizing  oxygenation  and  ventilation  
resulting  in  collapse  of  the  lung.   ◊ Maintaining  the  chest  tube  system  
Open   Pneumothorax   à   Air   enters   the   ◊ Providing   comfort   and   emotional  
pleural   space,   the   affected   lung   becomes   support  
compressed.   As   the   lung   collapses,   the   ◊ Observe  for  any  complications  
alveoli  become  underventilated,  causing  V/Q    
mismatching   and   intrapulmonary   shunting.   HEMOTHORAX   Occurs   when   pleural   space   fills  
Increased   pressure   within   the   chest   can   lead   with   blood.   It   usually   occurs   due   to   a   lacerated  
to  shifting  of  the  mediastinum,  compression   blood   vessel   in   thorax.   As   blood   increases,   it  
of   the   great   vessels,   and   decreased   cardiac   puts   pressure   on   heart   and   other   vessels   in  
output     chest  cavity.    
  Ø Symptoms    
Tension  Pneumothorax  à  Occurs  when  air  is   ◊ Anxiety/Restlessness  
allowed   to   enter   the   pleural   space   but   not   ◊ Tachypnea  
exit   it;   as   pressure   increases   inside   the   ◊ Signs  of  Shock  
pleural   space,   the   lung   collapses   and   the   ◊ Frothy,  Bloody  Sputum  
mediastinum  shifts  to  the  unaffected  side.   ◊ Diminished   Breath   Sounds   on   Affected  
Ø Symptoms     Side  
◊ Anxiety/Restlessness   ◊ Tachycardia  
◊ Severe  Dyspnea   ◊ Unequal  rising  of  the  chest  
◊ Absent  Breath  sounds  on  affected  side   Ø Management  
◊ Tachypnea  
 ◊ Thoracostomy   drainage   of   blood   in   the  
thoracic  cavity  (chest  tube  insertion)  
◊ Thrombolytic   agents   to   prevent   chest  
tube  clogging  
 
Ø Nursing  Management  
◊ Maintain   airway,   breathing   and  
circulation  (prepare  intubation  tray)  
◊ Position   in   semi-­‐fowler   position   with  
arms   elevated   on   pillows   to   promote  
lung  expansion  
◊ Establish   adequate   communication   to  
allay  anxiety