Chest injury

1. Presented by : Khadeeja Khurshid

2. After this presentation participant will be able to:
 Describe Anatomy of respiratory system.
 Explain mechanism of breathing.
 Define and classify chest trauma.
 Recognize Types of thoracic injuries.
 Explain MOI (thoracic injuries)
 Analyze Initial assessment .
 Manage thoracic injuries.
 Discuss Nursing Interventions.

3. RESPIRATOR
Y SYSTEM

7.  Nose
 Pharynx
 Larynx
 Trachea
 Bronchi
 Lungs – alveoli

8. • Primary bronchi
• Secondary bronchi
• Tertiary bronchi
• Bronchiole
• Terminal bronchiole

10. Two phases
Inspiration – flow of air into lung Expiration – air leaving lung

14. Chest trauma, is any form of physical injury to
the chest including the ribs, heart and lungs.
Epidemiology
A third of RTA’s have significant chest trauma
Approx. 80% is blunt chest trauma
 20 - 25% overall mortality
Majority of the deaths are preventable
< 10% of BCT require surgical intervention as
opposed to 15 - 30% in PCT

15.  Mainly two types:
1.Open chest injury (object penetrates the chest wall)
2.Closed chest injury ( skin is not broken e.g blunt trauma)
 Blunt Trauma- Blunt force to chest. E.g. automobile crashes and falls.
 Penetrating Trauma- Projectile that enters chest causing small or large hole. E.g
 . gun shot and stabbing.
 Compression Injury- Chest is caught between two objects and chest is compressed.

16.  Acceleration/ Deceler
 MVA
 Falls > 3m
 Sports
 Compression ( AP & transverse )
 Blast Injuries

17.  High velocity (Gun shot)
 Missile fragments
 Low velocity (Stab injury)

18. Rib fractures
Sternal fracture
 Flail chest
Pulmonary contusion
Pneumothorax
Haemothorax
Cardiac tamponade.
Aortic injury.

20. Principles of Resuscitation
Aim… To Restore Physiology, rather than anatomy
Early assessment and primary survey.
Simultaneous aggressive resuscitation.
Secondary survey with full examination.
Transfer to a definitive site of care.

21. Airway/spinal stabilization
Trachea, bronchial disruption, Breathing
Chest wall integrity, pneumothorax, flail
Circulation
Tamponade, hemothorax, tension pneumothorax
Cardiac or great vessel injury

22. “TREAT LIFE THREATENING
INJURIES AS THEY ARE
IDENTIFIED”

23. Rib fracture

24.  A rib fracture is a break in a rib bone. This typically results in chest pain that is
worse with breathing in. Bruising may occur at the site of the break. When
several ribs are broken in several places a flail chest results. Potential
complications include a pneumothorax, pulmonary contusion, and pneumonia.
 Rib fractures usually occur from a direct blows to the chest such as during a motor
vehicle collision or from a crush injury. Coughing or metastatic cancer may also
result in a broken rib. The middle ribs are most commonly fractured. Fractures of
the first or second ribs are more likely to be associated with complications.

26.  Fracture of sternum
 Also known as breast bone
 Located in center of chest
 The injury which occur 5-8% of people who experience significant , blunt chest
trauma, may occur in vehicle accident, when still moving chest strike steering
wheel or dash board or id injured by seatbelt.

27.  Injuries to chest are often life threatening and result
in one or more of the following pathologic mechanism
Hypoxemia from disruption of the airway
 Injury to lung parenchyma & rib cage
Respiratory musculature
Massive hemorrhage
Collapse lungs
Pneumothorax

28. Cardiac Failure:
Cardiac temponade
Cardiac contusion
Increased intrathoracic pressure
Hypovolemia
Massive fluid loss from great vessels
Cardiac rupture
Hemothorax

29.  An older adult
 Post menopausal women
 Using steroids for long time
 Having thoracic osteoporosis

30. DIRECT :
 Vehicle accidents
 Falls child abuse
INDIRECT:
 Repetitive trauma
 Severe and prolonged cough

31.  Localized pain
 Tenderness over the fractured area on inspiration and
palpation
 Shallow respiration
 Pain when coughing
 Swelling and bruising in the fracture area
 Internal bleeding
 Severe pain when rising the arm
 Stifness in shoulder joint

32.  History taking
 Physical examination(INSPECTION,AUSCALTATION,PALPATION AND PERCUSSION)
 X-rays chest
 CT scan of chest
 MRI or Bone scan
 Routine labs
 ABGs
 ECG

33.  Treatment depend upon the severity of the faracture.
 Follow RICE therapy.
 Take a break from sports to allow yourself to heal without hurting yourself again.
 Put ice on the area to relieve pain.
 Take pain medicine like analgesia (e.g acetaminophen or ibuprofen)
 Take deep breaths to avoid pneumonia.
 Don't wrap anything tightly around your ribs while they're healing.
 Average recovery time is about 10 weeks.

34.  Rib fractures can result from major trauma, such as a car crash. Rib bones moved
out of alignment can cause life-threatening complications including punctures and
damage to the lungs and other critical blood vessels or organs.
 When severe, rib fractures can lead to flail chest (open chest wound) and cause
breathing issues, pulmonary contusion, bleeding and pneumothorax.
 When untreated, rib fractures will lead to serious short-term consequences such
as severe pain when breathing, pneumonia and, rarely, death.

35.  The breaking of 2 or more ribs in two or
more places, resulting .
in free –floating ribs segments.
 An acute chest injury in which two or
more ribs become detached from the rest
of the ribcage.

36.  The flail segment has no bony or cartilaginous
connection
 Moves independently of the chest wall
 Paradoxical chest movement
FLIAL CHEST

37. PARADOXICAL
MOVEMENT
The flail portion of
the chest is
• sucked in with
inspiration, instead of
expanding outward
• Ballooned out with
expiration instead of
collapsing inward
•Hypoventilation and
hypoxemia

38.  Paradoxical Chest Movements.
 Crepitus (Grinding of bone ends on palpation).
 Severe chest pain
 Tenderness of affected area
 Breathing difficulties
 Inflammation and bruising
 Tachycardia
 Hypotension

39.  ABC’s with c-spine control as indicated
 High Flow oxygen
 Adequate analgesia (Including opiates)
 Intra-plural local analgesia
 Observe the patient for development of
 Pneumothorax and even worse Tension
 If Tension Develops Needle Decompress affected side
 Surgery -> internal operative fixation (rare)
 Rapid Transport! Remember a True Emergency

40.  Frequent and prompt Respiratory assessment
 Adequate oxygenation
 Analgesia to reduce pain.
 Clearing secretion
 Stabilize the thoracic cage
 Deep breathing exercises
 Intubation and mechanical ventilation may be required to prevent further
hypoxia.

41.  1. Intercostal Nerve Blocks
 2. Epidural Anesthesia.
 3. Wearing a chest binder
 Maintain IV flow rates
 Anxiety reducing techniques
 Coping mechanism
 Heath education/teaching

42.  PHYSIOTHERAPY(Better drainage of secretions)
 Coughing exercise
 spirometry

43.  Pneumonia
 ARDS
 Lung abscess
 Emphysema
 Pulmonary embolism.

63.  Cardiac Tamponade.
 Aortic injury.

65. Cardiac tamponade is
the compression of the
heart as a result of fluid
within the pericardial
sac.
It usually caused by
blunt or penetrating
trauma to the chest.

66. The three classic signs of cardiac tamponade, which doctors refer to as Beck's triad,
are:
Low blood pressure in the arteries
Muffled heart sounds
Distended veins (Swollen or bulging neck veins)
People with cardiac tamponade may also experience the following symptoms:
Weak pulse.
Cyanosis.
Irregular heart rhythms.
Fainting
Drowsiness
Sharp pain in the chest, back, abdomen, or shoulder
Shortness of breath

67.  Echocardiogram.
 Chest X-ray
 Electrocardiogram (ECG).

68.  Pericardiocentesis. The removal of fluid from the pericardium using a needle.
 Pericardiectomy. The surgical removal of part of the pericardium to relieve
pressure on the heart.
 Thoracotomy. A surgical procedure that allows the draining of blood or blood clots
around the heart.
 Pericardial Drain.

69. Continuous and vigilant respiratory assessment.
Optimizing oxygenation and ventilation.
Maintaining chest tube system.
Providing comfort and emotional support.
Maintaining surveillance for complication.
Monitor vital signs.
Maintenance of I/O chart.

70. Is the most common type of traumatic aortic injury and is a critical life-threatening,
and often life ending event.

71.  Approximately 80% of patients with thoracic aortic injury die at the scene of the
trauma.
 clinical diagnosis is difficult. The signs and symptoms are non-specific and
distracting injuries are often present.
 Clinical presentation may include
o chest or mid-scapular back pain,
o external chest trauma
o hemodynamic instability.

72.  Chest Xray.
 CT Angiography.
 MRI.
 Trans esophageal echocardiography.
 Intravascular ultrasound.

73.  Treatment and prognosis
 Aortic injury is a surgical emergency. Treatment is with an aortic stent graft or
open repair. Mortality is very high 3:
 >95% if untreated
 ~80% die immediately
 >30% if in hospital and treated

76.  Memorial Healthcare System. (2010). Pneumothorax (Collapsed Lung).
Retrieved from
https://secure.familyhealthtracker.com/deliver.aspx?s=sm&t=di&l=en&f
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ECC9259DE3AA%7D&key=26dd85c28d515a89bff6d8625ddf298a
 Thakur, R. K., & Mahomed, A. (2013). Correlating Radiology with
Thoracoscopic Findings in a Case of Primary Spontaneous
Pneumothorax in a Child. Journal of Minimally Invasive Surgical
Sciences, 2(3), 31-4
 LeMone, P., Luxford, Y., & Fagan, A. (2011). Medical-surgical nursing:
Critical thinking in client care (1st Australian ed. ). Frenchs Forest,
N.S.W.: Pearson Australia.
 Mayo Clinic. (2016). Pneumothorax. Retrieved from
http://www.mayoclinic.org/diseases-conditions/pneumothorax/home/ovc-

77.  Thorax is upper part of trunk.
 Bounded 12 ribs,vertebrae and sternum.
 Chest wall
 Two lungs and pleura.
 Great and thoracic vessels (aorta,superior and inferior vena cava)
 Heart and mediastinal structures.
 Diaphragm
 Esophagus.
 Thoracic duct.
 Tracheobroncial system.