Chest Trauma Lecture

Rose Bianchi, RN, DNSc. Copyright 2008

Two Categories of Chest Trauma ___________________________
1. Nonpenetrating Chest Injuries 2. Penetrating Chest Injuries

2. Rib Fractures Pneumothorax Pulmonary Contusion Cardiac Contusion . 4. 3.Types of Nonpenetrating Chest Injuries ___________________________ 1.

Types of Penetrating Chest Injuries ___________________________ 1. 2. Pneumothorax Aortic Tears Vena Cava Tears . 3.

Complications of Chest Trauma ************************** Pneumothorax Open Pneumothorax & Mediastinal Flutter Tension Pneumothorax & Mediastinal Shift Hemothorax Fractured Ribs Flail Chest .

Signs & Symptoms of Chest Trauma ___________________________ Chest Wall Bruising Chest Pain Dyspnea Cough Asymmetrical Chest Wall Movement Cyanosis .

Signs & Symptoms of Chest Trauma (Con¶t) __________________________Rapid. Weak Pulse Hypotension Trachea Deviation Distended Neck Veins Bloodshot or Bulging Eyes .

Assess for other injuries . Hct & Hgb. Remove clothes.Emergency Medical Treatment for Chest Trauma ___________________________ ‡ ‡ ‡ ‡ ‡ ‡ ‡ 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.

Emergency Treatment for Chest Trauma (Con¶t) __________________________ ‡ Seal open chest wound with a 3 sided air occlusive dressing ‡ Do not remove impaled object(s) .

Respiratory Assessment __________________________ Rate and Depth Lung Sounds Chest Movement SOB. Cyanosis Trachea Deviation Respiratory Stridor .

Respiratory Assessment (Con¶t) ___________________________ Accessory Muscle Use Intercostal Muscle Use Subcutaneous Emphysema ABGs .

Tension a. Open 3. Mediastinal Shift b.Types of Pneumothorax __________________________ 1. Closed 2. Mediastinal Flutter .

Chylothorax .Other Types of Chest Trauma ___________________________ 1. Hemothorax 2.

Anxiety Painful Breathing Decreased Chest Wall Movement Absent or Decreased Breath Sounds on the Affected Side .Signs & Symptoms of Pneumothorax ___________________________ Dyspnea. Tachypnea Tachycardia Restlessness.

Signs & Symptoms of Pneumothorax (Con¶t) ___________________________ Progressive Cyanosis Hyperresonance to Percussion on the Affected Side .

2. Intrapleural Tetracycline Autologous Blood Patches Fibrin Glue Talc Powder . 4.Medical Treatment for Persistent Air Leaks ___________________________ 1. 3.

___________________________ .

Alteration in Comfort (Pain) R/T Trauma.Nursing Diagnoses for the Client with Pneumothorax ___________________________ 1. Ineffective Breathing Patterns R/T Decreased Lung Expansion 2. Fear R/T Dyspnea 3. Altered Chest Cavity Pressure and Chest Tube .

Knowledge Deficit Regarding Condition & Treatment . High Risk for Infection R/T Traumatic Injury & Chest Tube Insertion 5.Nursing Diagnoses for the Client with Pneumothorax _____________________________________ 4.

Purpose 2. Placement .Chest Tubes ___________________________ 1.

2.Chest Tube Drainage System (Pleur-Evac) ___________________________ 1. 3. Collection Chamber Water seal Chamber Suction Chamber .

Assess Chest Tube & Drainage Devise 4.Nursing Assessments of the Patient with a Chest Tube _____________________________________ 1. Emergency Situations to Report to the M. Monitor Drainage 5. Monitor for S&S of Respiratory Distress 3.D. . CXR 2.

Keeping the Tubes Open (Patent) 4. Caring for the Drainage Collection Devise 5. Documentation .Care of the Patient with a Chest Tube & Chest Drainage Devise _____________________________________ 1. Safety 2. Preventing an Air Leak 3.

Thoracentesis ___________________________ 1. Definition 2. Most Common Post Procedure Symptom: Dyspnea .

Signs and Symptoms of Rib Fracture ___________________________ Pain Bruising Swelling Visible Bone Fragments Shallow Breathing Splinting Chest .

Signs and Symptoms of Flail Chest ___________________________ Severe Dyspnea Cyanosis Tachypnea Tachycardia Paradoxical Chest Movement ABGs :Hypoxemia. Hypercapnia .

Medical Treatment of Flail Chest ___________________________ O2 Deep Breathing & Cough Breathing Treatments ± IPPB Pain Control Monitor O2 Sats. Or ABGs Intubation & Mechanical Ventilation .

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