Chest trauma  nur 415-fall 2009
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Chest trauma nur 415-fall 2009

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Chest trauma  nur 415-fall 2009 Chest trauma nur 415-fall 2009 Presentation Transcript

  • Chest Trauma Qutaibah oudat jordan
  • Introduction
    • Chest trauma is often sudden and dramatic
    • Accounts for 25% of all trauma deaths
    • 2/3 of deaths occur after reaching hospital.
    • Associated with high mortality rate.
    • Serious pathological consequnces: -hypoxia, hypovolemia, myocardial failure.
  • Mechanism of Injury
    • Penetrating injuries
    • E.g. stab wounds etc.
    • Haemothorax
    • Pneumothorax
    • Cardiac, great vessel or oesophageal injury.
    • Great vessel injuries leads to death.
    • Early deaths occur (30 min-3 hrs after trauma.
    • Blunt injuries Either : - direct blow (e.g. rib fracture).
    • - compression injury.
  • Chest Wall Injuries
    • Rib fractures
    • Flail chest
    • Open pneumothorax
    • Rib fracture is the most common significant of blunt thoracic trauma:
    • Markers of serious intrathorasic & abdominal injuries.
    • Source of significant pain.
    • Predictor of pulmonary deterioration.
    • Fracture of scapula, sternum, or ribs.
    • 1 st -2nd rib # suggests massive force of injury or trauma.
  • Rib Fracture
    • 3 rd -9 th ribs associated with :
    • Blunt trauma.
    • Underlying lung injury.
    • Lower ribs associated with:
    • Injury to liver.
    • Injury to abdomen.
    • Upper ribs, clavicle or scapula fracture: suspect vascular injury
  • Rib fractures
    • Signs & Symptoms:
    • Localised pain, tenderness, crepitus
    • Diagnostic Procedure:
    • CXR to exclude other injuries
    • Management :
    • Air way management.
    • Pain management (analgesia & avoid taping).
    • Nurse must consider underlying structure and injury to them.
  • Flail chest
    • Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration.
    • Significant force required to cause # of multiple ribs.
    • usually Sternal # is present.
    • Usually diagnosed clinically
    • Rx :
    • ABC .
    • Analgesia.
    • Turn pt from side to side down to improve oxygenation .
    • Internal splitting used.
  • Flail chest
  • Flail Chest - detail
  • Lung injury
    • Pneumothorax
    • Haemothorax
    • Trachea and bronchial injuries
    • Pneumomediastinum
  • Pneumothorax
    • accumulation of Air or Gas between the (pleural cavity) parietal and visceral pleurae, leading to lung collapse.
    • Blunt or penetrating injury that disrupts the parietal or visceral pleura.
    • Degree of lung collapse determined by amount of trapped air or gas.
    • Most common types: open, closed, and tension.
  • Causes
    • Closed pneumothorax:
    • barotrauma.
  • S & S
    • Unilateral signs:
    • a.  movement and breath sounds,
    • b. resonant to percussion
    • Diagnostic Procedure:
    • Confirmed by CXR
    • Rx:
    • chest drain
  • Pneumothorax
  •  
  • Open Pneumothorax
    • Defect in chest wall provides a direct communication between the pleural space and the environment
    • Lung collapse and paroxysmal shifting of mediastinum with each respiratory effort ± tension pneumothorax .
    • Causes:
    • Central venous catheter insertion.
    • Chest surgery.
    • Penetrating chest injury.
    • Thoracentesis.
    • Percutaneous Lung Biopsy
    • Rx:
    • ABCs.
    • closure of wound.
    • chest drain.
  • Tension Pneumothorax
    • Air accumulates intrapleurally and can’t escape.
    • Air enters pleural space and cannot escape.
    • On Inspiration:
    • Increasing intrathorasic pressure cause the mediastinum to shift toward the unaffected lung, impairing ventilation.
    • On Expiration:
    • The mediastinal shift distorts the vena cava and reduce venous return, producing hypotension and shock.
  • Causes of Tension Pneumothorax
    • Chest tube occlusion or malfunction.
    • High positive end-expiratory pressures, causing rupture of alveolar blebs.
    • Lung or airway puncture from positive-pressure ventilation.
    • Mechanical ventilation after chest injury.
    • Penetrating chest wound.
  • Continue…..
    • P/C:
    • chest pain.
    • dyspnoea
    • Dx:
    • Respiratory distress symptoms.
    • Tracheal deviation (away)
    • Absence of breath sounds
    • Distended neck veins
    • Hypotension
    • Surgical emergency
    • Rx: emergency decompression before CXR
    • Either large bore cannula in 2nd ICS, MCL or insert chest tube
    • CXR to confirm site of insertion
  • Haemothorax
    • Blunt or penetrating trauma
    • Requires rapid decompression and fluid resuscitation
    • May require surgical intervention
    • Clinically: hypovolaemia absence of breath sounds dullness to percussion
    • CXR may be confused with collapse
  • Chest trauma: summary
    • Common
    • Serious
    • Primary goal is to provide oxygen to vital organs
    • Remember A irway B reathing C irculation
    • Be alert to change in clinical condition
  • Continue…..
    • ALERT If the patient’s chest tube dislodges, immediately place a petroleum gauze dressing over the opening.
    • ALERT Watch for signs and symptoms of tension pneumothorax, which can be fatal. these include anxiety, hypotension, tachycardia, tachypnea, and cyanosis.
  • Thanks