this document

2.  Differentiate between different mechanisms
of chest trauma.
 Explain different types of chest trauma & how
to provide a nursing care for each.
 Select nursing diagnoses and apply the
nursing process in the care of patients
experienced chest trauma

11.  Two types: open
and closed
 In a closed chest
injury, the skin is
not broken.
▪ Generally caused
by blunt trauma
Source: Courtesy of ED, Royal North Shore Hospital/NSW Institute of Trauma & Injury

12.  Closed chest injury (cont’d)
▪ Can cause significant cardiac and pulmonary
contusion
▪ If the heart is damaged, it may not be able to
refill with or receive blood.
▪ Lung tissue bruising can result in exponential loss
of surface area.
▪ Rib fractures may cause further damage.

13.  In an open chest
injury, an object
penetrates the
chest wall itself.
▪ Knife, gunshot, piece
of metal, or broken
end of fractured rib
▪ Do not attempt to
move or remove
object.

14.  Blunt trauma to the chest may cause:
▪ Rib, sternum, and chest wall fractures
▪ Bruising of the lungs and heart
▪ Damage to the aorta
▪ Vital organs to be torn from their attachment in
the chest cavity

15.  Signs and symptoms:
▪ Pain at the site of injury
▪ Localized pain aggravated or increased with
breathing
▪ Bruising to the chest wall
▪ Crepitus with palpation of the chest
▪ Penetrating injury to the chest
▪ Dyspnea

16.  Chest injury patients often have rapid and
shallow respirations.
▪ Hurts to take a deep breath
▪ Auscultate multiple locations to assess for
adequate breath sounds.

17. Major thoracic trauma can be remembered as
the (DEADLY DOZEN).
▪ “THE LETHAL SIX” is immediately life-
threatening injuries and should be sought in
primary survey.
▪ “HIDDEN SIX” are potentially life-
threatening injuries and should be detected
during the secondary survey.


18.  1- AIRWAY OBSTRUCTION:
▪ The most common cause in an unconscious
patient is the tongue fallen backward.
▪ Dentures, avulsed teeth, tissues, secretions,
and blood can contribute to airway
obstruction in trauma.
▪ Bilateral mandibular fracture
▪ Expanding neck hematoma.
▪ Direct laryngeotracheal trauma.


19. ▪ Physical Findings:
▪ Anxiety,
▪ stridor,
▪ hoarseness of voice,
▪ active accessory muscles,
▪ cyanosis,
▪ apnea.

21. ▪Treatment
▪ INTUBATION.

22.  air enters the pleural space from lung injury
or through the chest wall without a means of
exit.
 The affected lung collapses completely,
kinking of superior and inferior vena cava ,
decreased cardiac output.

25. ▪ Causes
▪ Penetrating injury to the chest.
▪ Blunt trauma with lung injury that did not
spontaneously close.

26. ▪ Severe respiratory distress.
▪ Severe hypotension .
▪ Hyperresonance to percussion
over affected hemothorax.
▪ Unilateral absence of breath
sound.
▪ Neck vein distension (absent in
hypovolemia).
▪ Cyanosis ).
▪ Tracheal shift to the other side.

27.  MANAGEMENT:
 Immediately needle decompression by
inserting a 12-14G catheter into second
intercostal space in the midclavicular line.
 Follow immediately with chest tube insertion.

28.  Commonly result from penetrating injury,but
it can also seen in blunt injury.The pericardial
sac does not acutely distend ;100-150 ml of
blood can produce tamponade.

29. ▪ persistent hypotension, acidosis, and base deficit
despite adequate blood and fluid resuscitation
▪ MUFFLED HEART SOUND.This triad only
present 33% of confirmed cases.

30. ▪ Pulsus paradoxcus:
decrease systolic Bp more
than 10mmHg during
inspiration.
▪ KAUSSMAUL’S sign:
which is jugular venous
distention during
spontaneous respiration.

31. ▪ Treatment
▪ It is emergent state, pericradiocentesis must be
done.
▪ patient should be taken to OR for thoracotomy

32. An open pneumothorax happens when air
builds up in the pleural cavity, the fluid-filled
space that directly surrounds the lungs, due
to a hole in the chest wall

33. ▪ Treatment :
▪ Three way dressing
▪ Early intubation and mechanical ventilation plus
surgical closure of the defect.

34. Evacuation of more than 1500 mL of blood
immediately after tube thoracostomy; this is
considered a massive hemothorax.
Continued bleeding from the chest, defined
as 150-200 mL/hr for 2-4 hours.
Repeated blood transfusion is required to
maintain hemodynamic stability.

36.  Treatment:
 - Airway- shock is compelling indication for
intubation.
 - Management of hemorrhagic shock.
 - Place a single chest tube (28F-32F) in fifth
intercostal space to decompress chest wall
cavity.

37. ▪ Flail chest is a life-threatening medical condition
that occurs when a segment of the rib cage
breaks due to trauma and becomes detached
from the rest of the chest wall.
▪ NB. Posterior rib fractures usually do not produce flail
segment due to heavy musculature provides stability.

38. ▪ Flail segment usually occurs when two or more ribs in
two or more separate locations with resultant
paradoxical motion of chest wall segment.
▪ associated with underlying lung contusion or hemo/
pneumothorax.

39.  • Treatment:
▪ - Pain Control
▪ Epidural controlled analgesia with local anesthetic
and/or opioids.
▪ Systemic NSAID may be used in mild cases.
▪ MechanicalVentilation may indicated


41. ▪ 1. THORACIC AORTIC DISRUPTION
▪ is a condition in which the aorta, the largest
artery in the body, is torn or ruptured as a result
of trauma to the body. The condition is frequently
fatal due to the profuse bleeding that results from
the rupture
▪ 85% of these individuals die at the scene.

42. ▪ Clinical signs:
- Decreased BP and Pulse pressure
- chest wall contusion.
- 50% of patients has absent signs of external
trauma.

43. ▪ X-ray finding:
▪ fracture of the first three ribs,scapula, or sternum;
▪ deviation of trachea to right.
▪ TEE
▪ CT

44. ▪ Treatment:
▪ Establish airway.
▪ Further surgical management for cardiac surgeon
assessment according to site of disruption

45. ▪ Most patients with major airway injuries
die at the scene as the result of asphyxia.
▪ Tracheobronchial injury is damage to
the tracheobronchial tree (the airway structure
involving the trachea and bronchi) It can result
from blunt or penetrating trauma to the neck
or chest

47.  Treatment:
▪ Airway management. Endotracheal intubation
with double lumen tube to isolate affected lung
▪ Immediate bronchoscopy if patient condition is
stable.
▪ CT scan chest with contrast
▪ Surgical repair according to site of injury.
▪


48. ▪ A blunt cardiac injury is an injury to the heart
as the result of blunt trauma, typically to the
anterior chest wall. It can result in a variety of
specific injuries to the heart, the most common
of which is a myocardial contusion

50.  Is a tear of the diaphragm, the muscle
across the bottom of the ribcage that
plays a crucial role in breathing. Most
commonly, acquired diaphragmatic tears
result from physical trauma

52.  Treatment
 Diaphragmatic tears will not heal
spontaneously. Surgical repair should be
done once diagnosed

53. ▪ Most injuries result from penetrating trauma.
Blunt injury is rare.
▪ In thoracic esophageal injury; subcutaneous
emphysema,pleural effusion.

54.  Esophagoscope is reliable in 60% of injuries.
 Esophagoscope plus esophagogram detect
90% of esophageal tears.
 Surgical management
 gastrostomy

55. ▪ PULMONARY contusion is an injury to the
lung tissue without actual structural
damage. Consequently, blood and other fluids
accumulate within lung tissues. Excess fluid
causes a decrease of breathing surface
leading to hypoxia
▪ This the most common potentially lethal chest
injury.

57.  • Treatment:
▪ Mild contusion-----> oxygen
administration+monitor saturation.
▪ Moderate to severe contusion-----
>intubate+mechanical ventilation.
▪

58.  Patient assessment steps
▪ Scene size-up
▪ Primary assessment
▪ History taking
▪ Secondary assessment
▪ Reassessment

59.  Scene safety
▪ Ensure the scene is safe for you, your partner,
your patient, and bystanders.
 Use gloves and eye protection.

60.  Mechanism of injury/nature of illness
▪ Chest injuries are common in motor vehicle
crashes, falls.
▪ Determine the number of patients.
▪ Consider spinal immobilization.

61.  Form a general impression (cont’d).
▪ Perform a rapid scan (cont’d).
▪ Assess the ABCs.
▪ Chest rise and fall on only one side
▪ Extended or engorged jugular veins
▪ Assess overall appearance.

62.  Airway and breathing
▪ Ensure that the patient has a clear and patent
airway.
▪ Consider early cervical spine stabilization.
▪ Are jugular veins distended
▪ Is breathing present and adequate

63.  Airway and breathing (cont’d)
▪ Look for equal expansion of the chest wall.
▪ Check for paradoxical motion.
▪ Apply occlusive dressing to all penetrating
injuries.
▪ Support ventilations.

64.  Circulation
▪ Pulse rate and quality
▪ Skin color and temperature
▪ Address life-threatening bleeding immediately,
using direct pressure.

65.  Transport decision
▪ Priority patients are those with a problem with
their ABCs.
▪ Pay attention to subtle clues, such as:
▪ The appearance of the skin
▪ Level of consciousness
▪ A sense of impending doom in the patient

66.  Transport
decision
(cont’d)
▪ Table 27-1 lists
the “deadly
dozen” chest
injuries.

67.  SAMPLE history

68.  SAMPLE history (cont’d)
▪ A basic evaluation should be completed:
▪ Signs and symptoms
▪ Allergies
▪ Medications
▪ Pertinent medical problems
▪ Last oral intake
▪ Events leading to the emergency

69.  Physical examinations
▪ Perform a full-body scan.
▪ For an isolated injury, focus on:
▪ Isolated injury
▪ Patient’s complaint
▪ Body region affected
▪ Location and extent of injury
▪ Anterior and posterior aspects of the chest wall
▪ Changes in respirations

70.  Physical examinations (cont’d)
▪ For significant trauma, use DCAP-BTLS to
determine the nature and extent of the thoracic
injury.
▪ Quickly assess the entire patient from head to
toe.

71. Deformities
Contusions
Abrasion
Penetrations
Burn
Tenderness
Lacerations
Swelling

72.  Vital signs
▪ Assess pulse, respirations, blood pressure, skin
condition, and pupils.
▪ Reevaluate every 5 minutes or less and according
patient case .
▪ Use a pulse oximeter to recognize any downward
trends in the patient’s condition.

73.  Repeat the primary assessment.
 Reassess the chief complaint.
▪ Airway
▪ Breathing
▪ Pulse
▪ Perfusion
▪ Bleeding

74.  Interventions
▪ Provide complete spinal immobilization for
patients with suspected spinal injuries.
▪ Maintain an open airway.
▪ Control significant, visible bleeding.
▪ Place an occlusive dressing over penetrating
trauma to the chest wall.

75.  Interventions (cont’d)
▪ Manually stabilize a flail segment using a bulky
dressing.
▪ Provide aggressive treatment for shock and
transport patients with signs of hypoperfusion.
▪ Do not delay transport to complete non
lifesaving treatments.

76.  Communication and documentation
▪ Communicate all relevant information to the
staff at the receiving hospital.
▪ Describe all injuries and the treatment given.