CHEST TRAUMA

INTRODUCTION
• Chest is large exposed portion of the body that is vulnerable to impact
Types of injuries Tension Pneumothorax Subcutaneous Emphysema
injuries. A. Specific chest injuries • Tension pneumothorax develops when a lung or • Air collects in subcutaneous fat from pressure of
• Because chest houses heart, lungs, great vessels chest trauma is frequently
life threatening . - BLUNT INJURIES chest wall injury is such that it allows air into air in pleural cavity
• Injuries to thoracic cage and its content can restrict the hearts ability to pump Rib fracture Sternum fracture the pleural space but not out of it (a one-way • Feels like rice crispies or bubble wrap
blood or lungs ability to exchange air and oxygenated blood.
• Major danger with chest injuries is internal bleeding and organ puncture Flail chest Pulmonary contusion valve). As a result, air accumulates and • Can be seen from neck to groin area
compresses the lung, eventually shifting the
Define chest trauma
- PENETRATING INJURIES
mediastinum, compressing the contralateral Flail Chest
Is any form of physical injury to the chest including the Gunshot and stab wound lung, and increasing intrathoracic pressure The breaking of 2 or more ribs in 2 or more places
ribs , heart and lungs . B. SPECIFIC PULMONARY INJURIES enough to decrease venous return to the heart, S/S of Flail Chest
Incidence of Chest Trauma
• Chest trauma is often sudden and dramatic. Pneumothorax Hemothorax causing shock. Air builds in pleural space with no • Shortness of Breath
• Accounts for 25% of all trauma deaths
where for the air to escape • Paradoxical Movement
Chylothorax Cardiac tamponade • Results in collapse of lung on affected side that
• 2/3 of deaths occur after reaching hospital. • Bruising/Swelling
Types of Nonpenetrating Chest Injuries results in pressure on the lung and great vessels • Crepitus( Grinding of bone ends on palpation)
Pathophysiology 1. Rib Fractures
• After blunt chest trauma released mediator such as 2. Pneumothorax Traumatic Aortic Rupture
prostanoids consisting of the prostaglandins S/S of Tension Treatment of Tension
(mediators of inflammatory)thrombxanes (mediators
3. Pulmonary Contusion Pneumothorax Pneumothorax • The heart, more or less, just hangs from the
of vasoconstriction), and the prostacyclins (active in 4. Cardiac Contusion • Anxiety/Restlessness 1. Confirm the aortic arch Much like a big pendulum.
the resolution phase of inflammation) lead to Types of Penetrating Chest Injuries • Severe Dyspnea affected side • If enough motion is placed on the heart (i.e..
cardiopulmonary changes. • Absent Breath sounds clinically. Deceleration From a motor vehicle accident etc)
• Blunt trauma commonly results in chest wall injuries 1. Pneumothorax
on affected side 2. Inform the patient. the heart may tear away from the aorta.
(eg, rib fractures). The pain associated with these 2 Aortic Tears
• Tachypnea 3. Antiseptic swab the • The chances of survival are very slim and are
injuries can make breathing difficult, and this may 3. Vena Cava Tears
compromise ventilation • Tachycardia skin at the 2nd based on the degree of the tear.
• Shunt and dead space ventilation produced by these • Poor Color intercostal space in • If there is just a small tear then the patient may
injuries can also impair oxygenation. Simple/Closed Pneumothorax • Accessory Muscle the mid-clavicular survive. If the aorta is completely transected
• pneumothorax, hemothorax , and hemopneumothorax • Opening in lung tissue that leaks air into chest then the patient will die instantaneously
interfere with oxygenation and ventilation by Use line.
cavity. The air is outside the lung but inside the • JVD 4. Insert needle
compressing otherwise healthy lung parenchyma. Symptoms and Signs of chest trauma
• Blunt trauma that causes significant cardiac injuries thoracic cavity. This places pressure on the lung • Narrowing Pulse decompression a 14
and can lead to its collapse and a shift of the  Pain, and shortness of breath .
(eg, chamber rupture) or severe great vessel injuries Pressures Gauge  chest tenderness, ecchymosis, and respiratory distress;
(eg, thoracic aortic disruption) , loss of cardiac pump surrounding structures • Hypotension 5. listen for bubbling‟ hypotension or shock may be present.
function as a result of hypovolemic or cardiogenic • Blunt trauma is main cause
shock and death before adequate treatment . • Tracheal Deviation to if the syringe barrel  Cyanosis.
• Usually self correcting the unaffected side is filled with water  Hemoptysis.
Main Causes of Chest Trauma Open Pneumothorax • Is mean Tracheal and the plunger  Chest wall contusion.
• Blunt Trauma- Blunt force to chest. • Opening in chest cavity that allows air to enter  Flail chest is a single rib may fracture in more than one
away from the removed),
pleural cavity. when air moves in and out of an place.
• Penetrating Trauma- Projectile that enters chest
open wound in the chest affected side, (late if 6. protect with gauze  Open wounds.
causing small or large hole. • Causes the lung to collapse due to increased seen at all) swab, tape,  Jugular vein distention (JVD) occur in tension
pressure in pleural cavity 7. set up chest drain pneumothorax or cardiac tamponade .
• Compression Injury- Chest is caught between two  Tracheal deviation.
• Can be life threatening and can deteriorate
objects and chest is compressed. rapidly  shock
Hemothorax
Role of nurse S/S of Open Pneumothorax Diagnosis for chest trauma
• Occurs when pleural space fills with blood • Clinical evaluation
• Determine etiology ,precipitating factors (trauma, complication • Dyspnea
of mechanical ventilation). • occurs due to lacerated blood vessel in thorax • Chest x-ray
• Check out respiratory function, noting rapid or shallow • Sudden sharp pain • As blood increases, it puts pressure on heart and • Sometimes other imaging studies (eg, CT,
respirations, dyspnea, reports of “air hunger,” development of • Subcutaneous emphysema other vessels in chest cavity ultrasonography, aortic imaging studies)
cyanosis, changes in v/s • Decreased lung sounds on affected side
• Note changes in airway pressures. • Each Lung can hold 1.5 liters of blood
• Observe for synchronous respiratory pattern when using • Red Bubbles on exhalation from wound ( S/S of Hemothorax Complications
mechanical ventilator. Note changes in airway pressures. • Clotted haemothorax
• Assist pt with splinting painful area when coughing, deep Sucking chest wound) air is sucked into the • Anxiety/Restlessness
breathing. thoracic cavity through the chest wall instead of • Empyema
• Maintain position of comfort, head of bed elevated. Turn to • Signs of Shock • Phrenic nerve palsy is a mixed motor/sensory nerve
affected side. Encourage pt to sit up as much as possible into the lungs through the airways. • Frothy, Bloody Sputum
• Observe for synchronous respiratory pattern when using that courses through the neck and thorax to
mechanical ventilator. Treatment for Open Pneumothorax • Diminished breath sounds on Affected Side innervate the diaphragm
• Pt has hemothorax has lost 1800mL of blood. will healthcare • Supplemental (100%) oxygen
provider expect when assessing this pt for decreased urine • Tachycardia , Tachypnea , Flat Neck Veins • Pericardial complications
output • Applying dressing Treatment for Hemothorax • Fistulae -Diaphragmatic hernia
Pain assessment: Identify pain mechanism ,Measure severity , • Inserting a chest drain and applying a totally • Chylothorax refers to the presence of lymphatic fluid
Identify any drug ,alcohol history ,Develop ncp for pain • 100% oxygen
occlusive dressing to the open wound. in the pleural space secondary to leakage from the
management including regular reassessment Administer drug assess • insertion of intercostal chest drain
effectiveness . Care of chest tube Occlusive Dressing : Asherman Chest Seal thoracic duct
• maintenance of circulating volume