Chest Trauma Lecture

Rose Bianchi, RN, DNSc.

Copyright 2008
Two Categories of Chest Trauma
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1. Nonpenetrating Chest Injuries

2. Penetrating Chest Injuries

 Types of Nonpenetrating
Chest Injuries
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1. Rib Fractures
2. Pneumothorax
3. Pulmonary Contusion
4. Cardiac Contusion
 Types of Penetrating
Chest Injuries
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1. Pneumothorax
2. Aortic Tears
3. Vena Cava Tears
Complications of Chest Trauma
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Pneumothorax
Open Pneumothorax & Mediastinal Flutter
Tension Pneumothorax & Mediastinal Shift
Hemothorax
Fractured Ribs
Flail Chest
 Signs & Symptoms of
Chest Trauma
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Chest Wall Bruising
Chest Pain
Dyspnea
Cough
Asymmetrical Chest Wall Movement
Cyanosis
 Signs & Symptoms of
Chest Trauma (Con’t)
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Rapid, Weak Pulse

Hypotension
Trachea Deviation
Distended Neck Veins
Bloodshot or Bulging Eyes
 Emergency Medical Treatment
for Chest Trauma
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• Patent Airway
• Assess S&S of Respiratory Distress
• Administer O2 & Continuous O2 sat monitoring
• Check Vital Signs & Assess for shock
• IV access x 2
• Check for Bleeding, Hct & Hgb.
• Remove clothes, Assess for other injuries
 Emergency Treatment for
Chest Trauma (Con’t)
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• Seal open chest wound with a 3 sided air
occlusive dressing
• Do not remove impaled object(s)
 Respiratory Assessment
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Rate and Depth

Lung Sounds
Chest Movement
SOB, Cyanosis
Trachea Deviation
Respiratory Stridor
 Respiratory Assessment (Con’t)
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Accessory Muscle Use

Intercostal Muscle Use
Subcutaneous Emphysema
ABGs
 Types of Pneumothorax
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1. Closed
2. Open
3. Tension
a. Mediastinal Shift
b. Mediastinal Flutter
 Other Types of Chest Trauma
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1. Hemothorax

2. Chylothorax
 Signs & Symptoms of
Pneumothorax
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Dyspnea, Tachypnea
Tachycardia
Restlessness, Anxiety
Painful Breathing
Decreased Chest Wall Movement
Absent or Decreased Breath Sounds on the Affected
Side
 Signs & Symptoms of
Pneumothorax (Con’t)
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Progressive Cyanosis
Hyperresonance to Percussion on the Affected
Side
Medical Treatment for Persistent
Air Leaks
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1. Intrapleural Tetracycline
2. Autologous Blood Patches
3. Fibrin Glue
4. Talc Powder
___________________________
Nursing Diagnoses for the Client
with Pneumothorax
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1. Ineffective Breathing Patterns R/T
Decreased Lung Expansion
2. Fear R/T Dyspnea
3. Alteration in Comfort (Pain) R/T Trauma,
Altered Chest Cavity Pressure and Chest
Tube
Nursing Diagnoses for the Client
with Pneumothorax
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4. High Risk for Infection R/T Traumatic

Injury & Chest Tube Insertion
5. Knowledge Deficit Regarding Condition
& Treatment
 Chest Tubes
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1. Purpose
2. Placement
 Chest Tube Drainage System
(Pleur-Evac)
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1. Collection Chamber
2. Water seal Chamber
3. Suction Chamber
 Nursing Assessments of the
Patient with a Chest Tube
_____________________________________
1. CXR
2. Monitor for S&S of Respiratory Distress
3. Assess Chest Tube & Drainage Devise
4. Monitor Drainage
5. Emergency Situations to Report to the
M.D.
 Care of the Patient with a Chest
Tube & Chest Drainage Devise
_____________________________________
1. Safety
2. Preventing an Air Leak
3. Keeping the Tubes Open (Patent)
4. Caring for the Drainage Collection Devise
5. Documentation
 Thoracentesis
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1. Definition
2. Most Common Post Procedure Symptom:
Dyspnea
 Signs and Symptoms of
Rib Fracture
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Pain
Bruising
Swelling
Visible Bone Fragments
Shallow Breathing
Splinting Chest
 Signs and Symptoms of
Flail Chest
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Severe Dyspnea
Cyanosis
Tachypnea
Tachycardia
Paradoxical Chest Movement
ABGs :Hypoxemia, Hypercapnia
Medical Treatment of Flail Chest
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O2
Deep Breathing & Cough
Breathing Treatments – IPPB
Pain Control
Monitor O2 Sats. Or ABGs
Intubation & Mechanical Ventilation