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CHEST TRAUMACHEST TRAUMA
SEMINAR ONSEMINAR ON
CHEST TRAUMACHEST TRAUMA
MR OM VERMAMR OM VERMA
Msc lecturer medical surgical nursingMsc lecturer medical surgical nursing
INTRODUCTION:INTRODUCTION:
 The chest is a large exposure part of theThe chest is a large exposure part of the
body that is very vul-nerable to impactbody that is very vul-nerable to impact
injuries. Because it houses the heart, lungs,injuries. Because it houses the heart, lungs,
and great vessels, chest trauma frequentlyand great vessels, chest trauma frequently
produces life threate-ning disruption. Injuryproduces life threate-ning disruption. Injury
to the thoracic case and its contraction canto the thoracic case and its contraction can
restrict the hearts ability to functionrestrict the hearts ability to function
properly.properly.
 Chest Injuries are broken into 2Chest Injuries are broken into 2
categories:categories:
– 1. Open chest injury-Must have opening or1. Open chest injury-Must have opening or
break in skin.break in skin.
– 2. Closed chest injury-Usually from blunt2. Closed chest injury-Usually from blunt
trauma to chest cavity.trauma to chest cavity.
DEFINITION:DEFINITION:
Chest Trauma / Thoracic TraumaChest Trauma / Thoracic Trauma
is a serious injury of the chest.is a serious injury of the chest.
Any trauma which leads to injuryAny trauma which leads to injury
to chest is termed as chestto chest is termed as chest
trauma.trauma.
 A CHEST INJURY IS ANY FROM OFA CHEST INJURY IS ANY FROM OF
PHYSICAL INJURY TO THE CHESTPHYSICAL INJURY TO THE CHEST
INCLUDING THE RIBS ,HEART,INCLUDING THE RIBS ,HEART,
LUNGSLUNGS
Mechanism of InjuryMechanism of Injury
in Chest Traumain Chest Trauma
 Acceleration/deceleration (motor vehicle accident)Acceleration/deceleration (motor vehicle accident)
 Body compression (crush injury)Body compression (crush injury)
 High-speed impact (gunshot wound)High-speed impact (gunshot wound)
 MiscellaneousMiscellaneous
Low-velocity penetrationLow-velocity penetration
(stab wound) KNIFE(stab wound) KNIFE
Airway obstructionAirway obstruction
(suffocation)(suffocation)
Caustic injury (poisoning)Caustic injury (poisoning)
BurnsBurns
ElectrocutionElectrocution
Main Causes of ChestMain Causes of Chest
TraumaTrauma
 Blunt TraumaBlunt Trauma- Blunt force to chest.- Blunt force to chest.
( gun shorts )( gun shorts )
 Penetrating TraumaPenetrating Trauma- Projectile that- Projectile that
enters chest causing small or large hole.enters chest causing small or large hole.
 Compression InjuryCompression Injury- Chest is caught- Chest is caught
between two objects and chest isbetween two objects and chest is
compressed.compressed.
Thoracic TraumaThoracic Trauma
 Blunt TraumaBlunt Trauma
– Results from kinetic energy forcesResults from kinetic energy forces
 Subdivision MechanismsSubdivision Mechanisms
– BlastBlast
 Pressure wave causes tissue disruptionPressure wave causes tissue disruption
 Tear blood vessels & disrupt alveolar tissueTear blood vessels & disrupt alveolar tissue
 Disruption of tracheobronchial treeDisruption of tracheobronchial tree
 Traumatic diaphragm ruptureTraumatic diaphragm rupture
– Crush (Compression)Crush (Compression)
 Body is compressed between an object and a hard surfaceBody is compressed between an object and a hard surface
 Direct injury of chest wall and internal structuresDirect injury of chest wall and internal structures
– DecelerationDeceleration
 Body in motion strikes a fixed objectBody in motion strikes a fixed object
 Blunt trauma to chest wallBlunt trauma to chest wall
 Internal structures continue in motionInternal structures continue in motion
– Ligamentum ArteriosumLigamentum Arteriosum shears aortashears aorta
– Age FactorsAge Factors
 Pediatric Thorax: More cartilage = Absorbs forcesPediatric Thorax: More cartilage = Absorbs forces
 Geriatric Thorax: Calcification & osteoporosis = More fracturesGeriatric Thorax: Calcification & osteoporosis = More fractures
 ASSESSMENTASSESSMENT
A. AirwayA. Airway
Assess for airway patency and airAssess for airway patency and air
exchange - listen at nose & mouthexchange - listen at nose & mouth
Assess for intercostal andAssess for intercostal and
supraclavicular muscle retractionssupraclavicular muscle retractions
Assess oropharynx for foreign bodyAssess oropharynx for foreign body
obstructionobstruction
B. BreathingB. Breathing
Assess respiratory movements andAssess respiratory movements and
quality of respirations - look, listen, feel.quality of respirations - look, listen, feel.
Slow respirations are early indicator ofSlow respirations are early indicator of
distress - cyanosis isdistress - cyanosis is late.late.
C.C. CirculationCirculation
Skin - look and feel for color,Skin - look and feel for color,
temperature, capillary refill- Look fortemperature, capillary refill- Look for
cyanosis.cyanosis.
Assess pulses for quality, rate, regularityAssess pulses for quality, rate, regularity
Look at neck veins - flat vs. distended-Look at neck veins - flat vs. distended-
fluid deficit or decreased supply to bodyfluid deficit or decreased supply to body
from heart due to compression.from heart due to compression.
Assess the B.P.Assess the B.P.
PATHOPHYSIOLOGYPATHOPHYSIOLOGY
CHEST INJURYCHEST INJURY
INTRAPLEURAL SPACE INCREASESINTRAPLEURAL SPACE INCREASES
LUNG COLLAPSELUNG COLLAPSE
MEDIASTINUM SHIFTMEDIASTINUM SHIFT
COMPRESSION OF LARGE VEINSCOMPRESSION OF LARGE VEINS
CARBON OXIDE DECREASESCARBON OXIDE DECREASES
CARDIAC ARRYTHMIASCARDIAC ARRYTHMIAS
a condition in which the heart beats with ana condition in which the heart beats with an
irregular or abnormal rhythm.irregular or abnormal rhythm.
SUDDEN DEATHSUDDEN DEATH
Diagnostic Evaluation:Diagnostic Evaluation:
 CHEST X- RAYCHEST X- RAY
 CT SCANCT SCAN
 ECHOCARDIOGRAPHYECHOCARDIOGRAPHY
 ABG ANALYSISABG ANALYSIS
 ANGIOGRAPHYANGIOGRAPHY
 BRONCHIOSCOPYBRONCHIOSCOPY
 PULSE OXIMETRY AND PFTPULSE OXIMETRY AND PFT
 URINE OUTPUTURINE OUTPUT
CHEST X- RAYCHEST X- RAY
 Chest XChest X--raysrays produce images of your produce images of your
heart, lungs, blood vessels, airways, andheart, lungs, blood vessels, airways, and
the bones of your the bones of your chestchest and spine and spine
 CT SCANCT SCAN
 A A chest injurychest injury is any form of physical is any form of physical
injury to the chest including the ribs, heartinjury to the chest including the ribs, heart
and lungs. ... Diagnosis of blunt injuriesand lungs. ... Diagnosis of blunt injuries
may be more difficult and requiremay be more difficult and require
additional investigations such as additional investigations such as CTCT
scanningscanning..
 ECHOCARDIOGRAPHYECHOCARDIOGRAPHY
 EchocardiographyEchocardiography  is a diagnostic test is a diagnostic test
that uses ultrasound waves to create anthat uses ultrasound waves to create an
image of the heart muscle, lungs .image of the heart muscle, lungs .
Ultrasound the heart can show the size,Ultrasound the heart can show the size,
shape, and movement of the heart'sshape, and movement of the heart's
valves and chambers as well as the flowvalves and chambers as well as the flow
of blood through the heart.of blood through the heart.
ABG ANALYSISABG ANALYSIS
 An An arterial blood gasarterial blood gas  ( (ABGABG) test) test
measures the acidity (pH) and themeasures the acidity (pH) and the
levels of oxygen and carbon dioxide inlevels of oxygen and carbon dioxide in
the blood from an artery. This test isthe blood from an artery. This test is
used to check how well your lungs areused to check how well your lungs are
able to move oxygen into the bloodable to move oxygen into the blood
and remove carbon dioxide from theand remove carbon dioxide from the
blood.blood.
ANGIOGRAPHYANGIOGRAPHY
 CT angiographyCT angiography uses a  uses a CTCT scanner scanner
to produce detailed images of bothto produce detailed images of both
blood vessels and tissues in variousblood vessels and tissues in various
parts of the body. An iodine-richparts of the body. An iodine-rich
contrast material (dye) is usuallycontrast material (dye) is usually
injected through a small catheterinjected through a small catheter
placed in a vein of the arm.placed in a vein of the arm.
Injuries of chestInjuries of chest
 Simple/Closed PneumothoraxSimple/Closed Pneumothorax
 Open PneumothoraxOpen Pneumothorax
 Tension PneumothoraxTension Pneumothorax
 Flail ChestFlail Chest
 Cardiac TamponadeCardiac Tamponade
 Traumatic Aortic RuptureTraumatic Aortic Rupture
 Traumatic AsphyxiaTraumatic Asphyxia
 Diaphragmatic RuptureDiaphragmatic Rupture
1. Simple/Closed1. Simple/Closed
PneumothoraxPneumothorax
o Accumulation of air in the pleural space without anAccumulation of air in the pleural space without an
apparent antecedent event.apparent antecedent event.
o Caused by rupture of smallCaused by rupture of small
blebs(small sac of the air ) on the visceral pleuralblebs(small sac of the air ) on the visceral pleural
spacespace
o Blunt trauma is mainBlunt trauma is main
o May be spontaneousMay be spontaneous
o Usually self correctingUsually self correcting
S/S of Simple/ClosedS/S of Simple/Closed
PneumothoraxPneumothorax
 Pleuritic Chest PainPleuritic Chest Pain
 DyspnoeaDyspnoea
 Tachypnea ( ABNORMAL RAPIDTachypnea ( ABNORMAL RAPID
BRATHING )BRATHING )
 Decreased Breath Sounds onDecreased Breath Sounds on
Affected SideAffected Side
 Hypertymphany to percussionHypertymphany to percussion
( like sound heard over air filled( like sound heard over air filled
structure during the abdominalstructure during the abdominal
examination
Treatment for Simple/ClosedTreatment for Simple/Closed
PneumothoraxPneumothorax
 ABC’s with C-spine controlABC’s with C-spine control
 Administer high concentration of oxygen to treatAdminister high concentration of oxygen to treat
hypoxiahypoxia
 Remove clothing to assess injuryRemove clothing to assess injury
 Insert chest tube with connection to suction toInsert chest tube with connection to suction to
remove remaining air and fluid / water sealremove remaining air and fluid / water seal
drainagedrainage
 Constant monitoringConstant monitoring
 Opening is plugged to align it with gauzeOpening is plugged to align it with gauze
impregnated with petroleum. A pressure dressingimpregnated with petroleum. A pressure dressing
is applied and secured with a circumferential strapis applied and secured with a circumferential strap
 Give semi- fowlers position or on injured siteGive semi- fowlers position or on injured site
 Administer AntibioticsAdminister Antibiotics
Ongoing monitoringOngoing monitoring
 Vital signsVital signs
 Level of consciousnessLevel of consciousness
 Oxygen saturationOxygen saturation
 Cardiac rhythmCardiac rhythm
 Respiratory statusRespiratory status
 Urinary outputUrinary output
2. Open Pneumothorax2. Open Pneumothorax
 Opening in chest cavityOpening in chest cavity
that allows air tothat allows air to
enter pleural cavity.enter pleural cavity.
 Causes the lung toCauses the lung to
collapse due to increasedcollapse due to increased
pressure in pleural cavity.pressure in pleural cavity.
E.g. Stab/ gunshot wounds.E.g. Stab/ gunshot wounds.
 Can be life threatening andCan be life threatening and
can deteriorate rapidlycan deteriorate rapidly
Open PneumothoraxOpen Pneumothorax
Open PneumothoraxOpen Pneumothorax
Inhale
Open PneumothoraxOpen Pneumothorax
Exhale
Open PneumothoraxOpen Pneumothorax
Inhale
Open PneumothoraxOpen Pneumothorax
Exhale
Open PneumothoarxOpen Pneumothoarx
Inhale
Open PnuemothoraxOpen Pnuemothorax
Inhale
S/S of OpenS/S of Open
PneumothoraxPneumothorax
 DyspneaDyspnea
 Sudden sharp painSudden sharp pain
 Subcutaneous EmphysemaSubcutaneous Emphysema
 Decreased lung sounds on affectedDecreased lung sounds on affected
sideside
 Red Bubbles on Exhalation fromRed Bubbles on Exhalation from
wound ( a.k.a. Sucking chestwound ( a.k.a. Sucking chest
wound)wound)
SubcutaneousSubcutaneous
EmphysemaEmphysema
 Air collects in subcutaneous fat fromAir collects in subcutaneous fat from
pressure of air in pleural cavitypressure of air in pleural cavity
 Feels like rice crispies or bubble wrapFeels like rice crispies or bubble wrap
 Can be seen from neck to groin areaCan be seen from neck to groin area
Sucking Chest WoundSucking Chest Wound
Treatment for OpenTreatment for Open
PneumothoraxPneumothorax
 ABC’s with c-spine control asABC’s with c-spine control as
indicatedindicated
 High Flow oxygenHigh Flow oxygen
 Listen for decreased breath sounds onListen for decreased breath sounds on
affected sideaffected side
 Apply occlusive dressing to woundApply occlusive dressing to wound
 Notify HospitalNotify Hospital
Occlusive/ Vented DressingOcclusive/ Vented Dressing
 Allows air to escapeAllows air to escape
from the vent andfrom the vent and
decreases thedecreases the
likelihood of tensionlikelihood of tension
pneumothoraxpneumothorax
developingdeveloping
Occlusive DressingOcclusive Dressing
 Asherman ChestAsherman Chest
SealSeal
3. Tension3. Tension
PneumothoraxPneumothorax
 Air builds in pleural space with noAir builds in pleural space with no
where for the air to escapewhere for the air to escape
 Results in collapse of lung on affectedResults in collapse of lung on affected
side that results in pressure onside that results in pressure on
mediastium,the other lung, and greatmediastium,the other lung, and great
vesselsvessels
Tension PneumothoraxTension Pneumothorax
Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..
Tension PneumothoraxTension Pneumothorax
Each time we inhale,
the lung collapses further. There
is no place for the air to
escape..
Tension PneumothoraxTension Pneumothorax
Heart is being
compressed
The trachea is
pushed to
the good side
S/S of TensionS/S of Tension
PneumothoraxPneumothorax
 Anxiety/RestlessneAnxiety/Restlessne
ssss
 Severe DyspneaSevere Dyspnea
 Absent BreathAbsent Breath
sounds on affectedsounds on affected
sideside
 TachypneaTachypnea
 TachycardiaTachycardia
 Poor ColorPoor Color
 Accessory MuscleAccessory Muscle
UseUse
 JVDJVD
 Narrowing PulseNarrowing Pulse
PressuresPressures
 HypotensionHypotension
 Tracheal DeviationTracheal Deviation
(late if seen at all)(late if seen at all)
TREATMENTTREATMENT
 Monitor Cardiac RhythmMonitor Cardiac Rhythm
 Establish IV access and Draw BloodEstablish IV access and Draw Blood
SamplesSamples
 Airway control including IntubationAirway control including Intubation
 Needle Decompression of AffectedNeedle Decompression of Affected
SideSide
Needle DecompressionNeedle Decompression
 Locate 2-3 Intercostals space midclavicularLocate 2-3 Intercostals space midclavicular
lineline
 Cleanse area using aseptic techniqueCleanse area using aseptic technique
 Insert catheter ( 14g or larger) at least 3” inInsert catheter ( 14g or larger) at least 3” in
length over the top of the 3length over the top of the 3rdrd
rib( nerve,rib( nerve,
artery, vein lie along bottom of rib)artery, vein lie along bottom of rib)
 Remove Stylette ( a flexible metallic rodRemove Stylette ( a flexible metallic rod
inserted in the lumen of a flexible catheter )inserted in the lumen of a flexible catheter )
and listen for rush of airand listen for rush of air
 Place Flutter valve over catheterPlace Flutter valve over catheter
 Reassess for ImprovementReassess for Improvement
Needle DecompressionNeedle Decompression
4, Hemothorax4, Hemothorax
 Occurs when pleural space fills withOccurs when pleural space fills with
bloodblood
 Usually occurs due to lacerated bloodUsually occurs due to lacerated blood
vessel in thoraxvessel in thorax
 As blood increases, it puts pressureAs blood increases, it puts pressure
on heart and other vessels in cheston heart and other vessels in chest
cavitycavity
 Each Lung can hold 1.5 liters of bloodEach Lung can hold 1.5 liters of blood
HemothoraxHemothorax
HemothoraxHemothorax
HemothoraxHemothorax
HemothoraxHemothorax
HemothoraxHemothorax
HemothoraxHemothorax
May put pressure on the heart
HemothoraxHemothorax
Lots of blood vessels
Where does the blood come
from.
S/S of HemothoraxS/S of Hemothorax
 Anxiety/RestlessnessAnxiety/Restlessness
 TachypneaTachypnea
 Signs of ShockSigns of Shock
 Frothy, Bloody SputumFrothy, Bloody Sputum
 Diminished Breath Sounds on AffectedDiminished Breath Sounds on Affected
SideSide
 TachycardiaTachycardia
 Flat Neck VeinsFlat Neck Veins
Treatment forTreatment for
HemothoraxHemothorax
 ABC’s with c-spine control asABC’s with c-spine control as
indicatedindicated
 Secure Airway assist ventilation ifSecure Airway assist ventilation if
necessarynecessary
 General Shock Care due to Blood lossGeneral Shock Care due to Blood loss
 Consider Left Lateral RecumbentConsider Left Lateral Recumbent
position if not contraindicatedposition if not contraindicated
 RAPID TRANSPORTRAPID TRANSPORT
 Contact HospitalContact Hospital
5. Flail Chest5. Flail Chest
The breaking of 2The breaking of 2
or more ribs in 2or more ribs in 2
or more placesor more places
Flail ChestFlail Chest
S/S of Flail ChestS/S of Flail Chest
 Shortness of Breath, respiratoryShortness of Breath, respiratory
distress, Pneumothoraxdistress, Pneumothorax
 Paradoxical MovementParadoxical Movement
 Bruising/SwellingBruising/Swelling
 Crepitus( Grinding of bone ends onCrepitus( Grinding of bone ends on
palpation)palpation)
 HypotensionHypotension
Treatment of Flail ChestTreatment of Flail Chest
 Flail Chest is a True EmergencyFlail Chest is a True Emergency
 Ensure airwayEnsure airway
 Administer oxygenAdminister oxygen
 Assist ventilation. Chest decompression is doneAssist ventilation. Chest decompression is done
for pneumothorax.for pneumothorax.
 Establish I/V lineEstablish I/V line
 Restrict fluid intake, prescribe corticosteroids andRestrict fluid intake, prescribe corticosteroids and
albumin to treat pulmonary contusionalbumin to treat pulmonary contusion
 Prepare for operative stabilization of chest wallPrepare for operative stabilization of chest wall
Bulky Dressing for splintBulky Dressing for splint
of Flail Chestof Flail Chest
 Use TraumaUse Trauma
bandage andbandage and
TriangularTriangular
Bandages to splintBandages to splint
ribs.ribs.
 Can also place aCan also place a
bag of D5W onbag of D5W on
area and tapearea and tape
down. (The onlydown. (The only
good use of D5W Igood use of D5W I
can find)can find)
6. Pericardial6. Pericardial
TamponadeTamponade Blood and fluidsBlood and fluids
leak into theleak into the
pericardial sacpericardial sac
which surrounds thewhich surrounds the
heart.heart.
As the pericardialAs the pericardial
sac fills, it causessac fills, it causes
the sac to expandthe sac to expand
until it cannotuntil it cannot
expand anymoreexpand anymorepericardial sac
Pericardial TamponadePericardial Tamponade
Once theOnce the
pericardial sacpericardial sac
can’t expandcan’t expand
anymore, theanymore, the
fluid starts puttingfluid starts putting
pressure on thepressure on the
heartheart
Now the heartNow the heart
can’t fully expandcan’t fully expand
and can’t pumpand can’t pump
effectively.effectively.
Pericardial TamponadePericardial Tamponade
With poor pumpingWith poor pumping
the blood pressurethe blood pressure
starts to drop.starts to drop.
The heart rate startsThe heart rate starts
to increase toto increase to
compensate but iscompensate but is
unableunable
The patient’s level ofThe patient’s level of
conscious drops, andconscious drops, and
eventually the patienteventually the patient
goes in cardiac arrestgoes in cardiac arrest
pericardial tamponadepericardial tamponade ,,
is when fluid inis when fluid in
the the pericardiumpericardium (the sac (the sac
around the heart) builds up andaround the heart) builds up and
results in compression of theresults in compression of the
heart. .heart. .
S/S of PericardialS/S of Pericardial
TamponadeTamponade
 Distended Neck VeinsDistended Neck Veins
 Increased Heart RateIncreased Heart Rate
 Respiratory Rate increases, cyanosisRespiratory Rate increases, cyanosis
 Anxious, confusedAnxious, confused
 Muffled heart soundMuffled heart sound
 Hypotension, pulses paradoxesHypotension, pulses paradoxes
 Shock, DeathShock, Death
Treatment of PericardialTreatment of Pericardial
TamponadeTamponade
 Check for ABCCheck for ABC
 High Flow oxygen which may includeHigh Flow oxygen which may include
BVMBVM
 Treat S/S of shockTreat S/S of shock
 Assist with pericardiocentesisAssist with pericardiocentesis
 Prepare for emergency thoracotomyPrepare for emergency thoracotomy
TreatmentTreatment
 Cardiac MonitorCardiac Monitor
 Large Bore IV accessLarge Bore IV access
 Perform pericardiocentesisPerform pericardiocentesis
PericardiocentesisPericardiocentesis
 Using aseptic technique, Insert at least needle atUsing aseptic technique, Insert at least needle at
the angle of the Xiphoid Cartilage at the 7the angle of the Xiphoid Cartilage at the 7thth
ribrib
 Advance needle at 45 degree towards the clavicleAdvance needle at 45 degree towards the clavicle
while aspirating syringe till blood return is seenwhile aspirating syringe till blood return is seen
 Continue to Aspirate till syringe is full then discardContinue to Aspirate till syringe is full then discard
blood and attempt again till signs of no more bloodblood and attempt again till signs of no more blood
 Closely monitor patient due to small about of bloodClosely monitor patient due to small about of blood
aspirated can cause a rapid change in bloodaspirated can cause a rapid change in blood
pressurepressure
7. Traumatic Aortic7. Traumatic Aortic
RuptureRupture
The heart, more or less, just
hangs from the aortic arch
Much like a big pendulum.
If enough motion is placed on
the heart (i.e.. Deceleration
From a motor vehicle
accident, striking a tree while
skiing etc) the heart may tear
away from the aorta.
Traumatic Aortic RuptureTraumatic Aortic Rupture
The chances of survival are
very slim and are based on the
degree of the tear.
If there is just a small tear then
the patient may survive. If the
aorta is completely transected
then the patient will die
instantaneously
S/S Of Traumatic AorticS/S Of Traumatic Aortic
RuptureRupture
 Burning or Tearing Sensation in chestBurning or Tearing Sensation in chest
or shoulder bladesor shoulder blades
 Rapidly dropping Blood PressureRapidly dropping Blood Pressure
 Pulse Rapidly IncreasingPulse Rapidly Increasing
 Decreased or loss of pulse or b/p onDecreased or loss of pulse or b/p on
left side compared to right sideleft side compared to right side
 Rapid Loss of ConsciousnessRapid Loss of Consciousness
TreatmentTreatment
 Monitor Cardiac RhythmMonitor Cardiac Rhythm
 Large Bore IV therapy probably 2 andLarge Bore IV therapy probably 2 and
draw blood samplesdraw blood samples
 Airway management that may includeAirway management that may include
IntubationIntubation
8. Traumatic Asphyxia8. Traumatic Asphyxia
 Results from sudden compressionResults from sudden compression
injury to chest cavityinjury to chest cavity
 Can cause massive rupture of VesselsCan cause massive rupture of Vessels
and organs of chest cavityand organs of chest cavity
 Ultimately DeathUltimately Death
S/S of TraumaticS/S of Traumatic
AsphyxiaAsphyxia
 Severe DyspneaSevere Dyspnea
 Distended Neck VeinsDistended Neck Veins
 Bulging, Blood shot eyesBulging, Blood shot eyes
 Swollen Tounge with cyanotic lipsSwollen Tounge with cyanotic lips
 Reddish-purple discoloration of faceReddish-purple discoloration of face
and neckand neck
 PetechiaePetechiae
TreatmentTreatment
 Cardiac MonitorCardiac Monitor
 Establish IV Access and draw bloodEstablish IV Access and draw blood
samplessamples
 Airway control including IntubationAirway control including Intubation
 Rapid transportRapid transport
9. Diaphragmatic9. Diaphragmatic
RuptureRupture
 A tear in the Diaphragm that allowsA tear in the Diaphragm that allows
the abdominal organs enter the chestthe abdominal organs enter the chest
cavitycavity
 More common on Left side due to liverMore common on Left side due to liver
helps protect the right side ofhelps protect the right side of
diaphragmdiaphragm
 Associated with multipile injuryAssociated with multipile injury
patientspatients
Diaphragm RuptureDiaphragm Rupture
S/S of DiaphragmaticS/S of Diaphragmatic
RuptureRupture
 Abdominal PainAbdominal Pain
 Shortness of AirShortness of Air
 Decreased Breath Sounds on side ofDecreased Breath Sounds on side of
rupturerupture
 Bowel Sounds heard in chest cavityBowel Sounds heard in chest cavity
TreatmentTreatment
 Cardiac MonitorCardiac Monitor
 Establish IV access and draw bloodEstablish IV access and draw blood
samplessamples
 Airway management including IntubationAirway management including Intubation
 Observe for Pneumothorax due toObserve for Pneumothorax due to
compression on lung by abdominal contentscompression on lung by abdominal contents
 Possible insertion of NG tube to helpPossible insertion of NG tube to help
decompress the stomach to relieve pressuredecompress the stomach to relieve pressure
Management of patients withManagement of patients with
Thoracic TraumaThoracic Trauma
 The treatment of polytraumatized patient mustThe treatment of polytraumatized patient must
follow a certain protocol which includes.follow a certain protocol which includes.
– Adequate oxygenation.Adequate oxygenation.
– Fluid replacement.Fluid replacement.
– Surgical intervention.Surgical intervention.
– Treatment of septic complications.Treatment of septic complications.
– Adequate caloric and substrate supplementation.Adequate caloric and substrate supplementation.
– Prevention of stress bleeding.Prevention of stress bleeding.
– Finally, be alert of possible complication (CNS, ARDS,Finally, be alert of possible complication (CNS, ARDS,
hepatic, renal, coagulation disorders, sepsis.hepatic, renal, coagulation disorders, sepsis.
RIB FRACTURE:RIB FRACTURE:
 SIGN AND SYMPTOMS:
 SEVERE PAIN, TENDERNESSSEVERE PAIN, TENDERNESS
 MUSCLE SPASM WHICH AGGRAVATEMUSCLE SPASM WHICH AGGRAVATE
WITH COUGHING , DEEP BREATHINGWITH COUGHING , DEEP BREATHING
AND MOTIONAND MOTION
 CRACKLING SOUND WITH GRATINGCRACKLING SOUND WITH GRATING
 UNSTABLE RIB CAGE ON PALPATIONUNSTABLE RIB CAGE ON PALPATION
TREATMENTTREATMENT
 ENSURE AIRWAY AND ADMINISTERENSURE AIRWAY AND ADMINISTER
OXYGENOXYGEN
 Stabilize with hand followed by applicationStabilize with hand followed by application
of large pieces of tape horizontal acrossof large pieces of tape horizontal across
the flail segmentthe flail segment
 GIVE ANALGESICGIVE ANALGESIC
 ENCOURAGE FOR DEEP BREATHINGENCOURAGE FOR DEEP BREATHING
 MAINTAIN PATENT I/V LINEMAINTAIN PATENT I/V LINE
ASSESSMENT:ASSESSMENT:
 A-A- AIRWAY MAINTENANCE WITHAIRWAY MAINTENANCE WITH
CERVICAL SPINE PROTECTIONCERVICAL SPINE PROTECTION
 B-B- BREATHING AND VENTILATIONBREATHING AND VENTILATION
 C-C- CIRCULATION WITH HEMORRHAGECIRCULATION WITH HEMORRHAGE
CONTROLCONTROL
 D-D- DISABILITY, NEUROLOGICALDISABILITY, NEUROLOGICAL
STATUSSTATUS
 E-E- EXPOSURE/ ENVIRONMENTALEXPOSURE/ ENVIRONMENTAL
CONTROL, PREVENT HYPOTHERMIACONTROL, PREVENT HYPOTHERMIA
NURSING PROCESSNURSING PROCESS
 INEFFECTIVE BREATHING PATTERN RELATEDINEFFECTIVE BREATHING PATTERN RELATED
TO CHEST INJURYTO CHEST INJURY
 RISK FOR DEFICIENT FLUID VOLUME RELATEDRISK FOR DEFICIENT FLUID VOLUME RELATED
TO CHEST DRAINAGE AND BLOOD LOSSTO CHEST DRAINAGE AND BLOOD LOSS
 ACUTE PAIN RELATED TO CHEST INJURY ANDACUTE PAIN RELATED TO CHEST INJURY AND
PRESENCE OF DRAINAGE TUBES IN THE CHESTPRESENCE OF DRAINAGE TUBES IN THE CHEST
 IMPAIRED PHYSICAL MOBILITY RELATED TOIMPAIRED PHYSICAL MOBILITY RELATED TO
PAIN, MUSCLE INJURYPAIN, MUSCLE INJURY
 RISK FOR INEFFECTIVE INDIVIDUAL COPINGRISK FOR INEFFECTIVE INDIVIDUAL COPING
RELATED TORELATED TO
TEMPORARY DEPENDENCE AND LOSS OF FULLTEMPORARY DEPENDENCE AND LOSS OF FULL
RESPIRATORY FUNCTIONRESPIRATORY FUNCTION
COMPLICATIONCOMPLICATION
 ASPIRATIONASPIRATION
 ATELECTESIS ( collapse or closure ofATELECTESIS ( collapse or closure of
a lung )a lung )
 INFECTIONINFECTION
 PNEUMONIAPNEUMONIA
 RESPIRARATORY FAILURERESPIRARATORY FAILURE
=inadequate gas exchange by the=inadequate gas exchange by the
respiratory systemrespiratory system
SummarySummary
Chest Injuries are common and often lifeChest Injuries are common and often life
threatening in trauma patients. So, Rapidthreatening in trauma patients. So, Rapid
identification and treatment of these patients isidentification and treatment of these patients is
paramount to patient survival. Airwayparamount to patient survival. Airway
management is very important and aggressivemanagement is very important and aggressive
management is sometimes needed for propermanagement is sometimes needed for proper
management of most chest injuries.management of most chest injuries.
Chest trauma  presentation

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Chest trauma presentation

  • 2. SEMINAR ONSEMINAR ON CHEST TRAUMACHEST TRAUMA MR OM VERMAMR OM VERMA Msc lecturer medical surgical nursingMsc lecturer medical surgical nursing
  • 3. INTRODUCTION:INTRODUCTION:  The chest is a large exposure part of theThe chest is a large exposure part of the body that is very vul-nerable to impactbody that is very vul-nerable to impact injuries. Because it houses the heart, lungs,injuries. Because it houses the heart, lungs, and great vessels, chest trauma frequentlyand great vessels, chest trauma frequently produces life threate-ning disruption. Injuryproduces life threate-ning disruption. Injury to the thoracic case and its contraction canto the thoracic case and its contraction can restrict the hearts ability to functionrestrict the hearts ability to function properly.properly.
  • 4.  Chest Injuries are broken into 2Chest Injuries are broken into 2 categories:categories: – 1. Open chest injury-Must have opening or1. Open chest injury-Must have opening or break in skin.break in skin. – 2. Closed chest injury-Usually from blunt2. Closed chest injury-Usually from blunt trauma to chest cavity.trauma to chest cavity.
  • 5. DEFINITION:DEFINITION: Chest Trauma / Thoracic TraumaChest Trauma / Thoracic Trauma is a serious injury of the chest.is a serious injury of the chest. Any trauma which leads to injuryAny trauma which leads to injury to chest is termed as chestto chest is termed as chest trauma.trauma.
  • 6.  A CHEST INJURY IS ANY FROM OFA CHEST INJURY IS ANY FROM OF PHYSICAL INJURY TO THE CHESTPHYSICAL INJURY TO THE CHEST INCLUDING THE RIBS ,HEART,INCLUDING THE RIBS ,HEART, LUNGSLUNGS
  • 7. Mechanism of InjuryMechanism of Injury in Chest Traumain Chest Trauma  Acceleration/deceleration (motor vehicle accident)Acceleration/deceleration (motor vehicle accident)  Body compression (crush injury)Body compression (crush injury)  High-speed impact (gunshot wound)High-speed impact (gunshot wound)  MiscellaneousMiscellaneous Low-velocity penetrationLow-velocity penetration (stab wound) KNIFE(stab wound) KNIFE Airway obstructionAirway obstruction (suffocation)(suffocation) Caustic injury (poisoning)Caustic injury (poisoning) BurnsBurns ElectrocutionElectrocution
  • 8. Main Causes of ChestMain Causes of Chest TraumaTrauma  Blunt TraumaBlunt Trauma- Blunt force to chest.- Blunt force to chest. ( gun shorts )( gun shorts )  Penetrating TraumaPenetrating Trauma- Projectile that- Projectile that enters chest causing small or large hole.enters chest causing small or large hole.  Compression InjuryCompression Injury- Chest is caught- Chest is caught between two objects and chest isbetween two objects and chest is compressed.compressed.
  • 9. Thoracic TraumaThoracic Trauma  Blunt TraumaBlunt Trauma – Results from kinetic energy forcesResults from kinetic energy forces  Subdivision MechanismsSubdivision Mechanisms – BlastBlast  Pressure wave causes tissue disruptionPressure wave causes tissue disruption  Tear blood vessels & disrupt alveolar tissueTear blood vessels & disrupt alveolar tissue  Disruption of tracheobronchial treeDisruption of tracheobronchial tree  Traumatic diaphragm ruptureTraumatic diaphragm rupture – Crush (Compression)Crush (Compression)  Body is compressed between an object and a hard surfaceBody is compressed between an object and a hard surface  Direct injury of chest wall and internal structuresDirect injury of chest wall and internal structures – DecelerationDeceleration  Body in motion strikes a fixed objectBody in motion strikes a fixed object  Blunt trauma to chest wallBlunt trauma to chest wall  Internal structures continue in motionInternal structures continue in motion – Ligamentum ArteriosumLigamentum Arteriosum shears aortashears aorta – Age FactorsAge Factors  Pediatric Thorax: More cartilage = Absorbs forcesPediatric Thorax: More cartilage = Absorbs forces  Geriatric Thorax: Calcification & osteoporosis = More fracturesGeriatric Thorax: Calcification & osteoporosis = More fractures
  • 11. A. AirwayA. Airway Assess for airway patency and airAssess for airway patency and air exchange - listen at nose & mouthexchange - listen at nose & mouth Assess for intercostal andAssess for intercostal and supraclavicular muscle retractionssupraclavicular muscle retractions Assess oropharynx for foreign bodyAssess oropharynx for foreign body obstructionobstruction
  • 12. B. BreathingB. Breathing Assess respiratory movements andAssess respiratory movements and quality of respirations - look, listen, feel.quality of respirations - look, listen, feel. Slow respirations are early indicator ofSlow respirations are early indicator of distress - cyanosis isdistress - cyanosis is late.late.
  • 13. C.C. CirculationCirculation Skin - look and feel for color,Skin - look and feel for color, temperature, capillary refill- Look fortemperature, capillary refill- Look for cyanosis.cyanosis. Assess pulses for quality, rate, regularityAssess pulses for quality, rate, regularity Look at neck veins - flat vs. distended-Look at neck veins - flat vs. distended- fluid deficit or decreased supply to bodyfluid deficit or decreased supply to body from heart due to compression.from heart due to compression. Assess the B.P.Assess the B.P.
  • 14. PATHOPHYSIOLOGYPATHOPHYSIOLOGY CHEST INJURYCHEST INJURY INTRAPLEURAL SPACE INCREASESINTRAPLEURAL SPACE INCREASES LUNG COLLAPSELUNG COLLAPSE MEDIASTINUM SHIFTMEDIASTINUM SHIFT
  • 15. COMPRESSION OF LARGE VEINSCOMPRESSION OF LARGE VEINS CARBON OXIDE DECREASESCARBON OXIDE DECREASES CARDIAC ARRYTHMIASCARDIAC ARRYTHMIAS a condition in which the heart beats with ana condition in which the heart beats with an irregular or abnormal rhythm.irregular or abnormal rhythm. SUDDEN DEATHSUDDEN DEATH
  • 16. Diagnostic Evaluation:Diagnostic Evaluation:  CHEST X- RAYCHEST X- RAY  CT SCANCT SCAN  ECHOCARDIOGRAPHYECHOCARDIOGRAPHY  ABG ANALYSISABG ANALYSIS  ANGIOGRAPHYANGIOGRAPHY  BRONCHIOSCOPYBRONCHIOSCOPY  PULSE OXIMETRY AND PFTPULSE OXIMETRY AND PFT  URINE OUTPUTURINE OUTPUT
  • 17. CHEST X- RAYCHEST X- RAY  Chest XChest X--raysrays produce images of your produce images of your heart, lungs, blood vessels, airways, andheart, lungs, blood vessels, airways, and the bones of your the bones of your chestchest and spine and spine  CT SCANCT SCAN  A A chest injurychest injury is any form of physical is any form of physical injury to the chest including the ribs, heartinjury to the chest including the ribs, heart and lungs. ... Diagnosis of blunt injuriesand lungs. ... Diagnosis of blunt injuries may be more difficult and requiremay be more difficult and require additional investigations such as additional investigations such as CTCT scanningscanning..
  • 18.  ECHOCARDIOGRAPHYECHOCARDIOGRAPHY  EchocardiographyEchocardiography  is a diagnostic test is a diagnostic test that uses ultrasound waves to create anthat uses ultrasound waves to create an image of the heart muscle, lungs .image of the heart muscle, lungs . Ultrasound the heart can show the size,Ultrasound the heart can show the size, shape, and movement of the heart'sshape, and movement of the heart's valves and chambers as well as the flowvalves and chambers as well as the flow of blood through the heart.of blood through the heart.
  • 19. ABG ANALYSISABG ANALYSIS  An An arterial blood gasarterial blood gas  ( (ABGABG) test) test measures the acidity (pH) and themeasures the acidity (pH) and the levels of oxygen and carbon dioxide inlevels of oxygen and carbon dioxide in the blood from an artery. This test isthe blood from an artery. This test is used to check how well your lungs areused to check how well your lungs are able to move oxygen into the bloodable to move oxygen into the blood and remove carbon dioxide from theand remove carbon dioxide from the blood.blood.
  • 20. ANGIOGRAPHYANGIOGRAPHY  CT angiographyCT angiography uses a  uses a CTCT scanner scanner to produce detailed images of bothto produce detailed images of both blood vessels and tissues in variousblood vessels and tissues in various parts of the body. An iodine-richparts of the body. An iodine-rich contrast material (dye) is usuallycontrast material (dye) is usually injected through a small catheterinjected through a small catheter placed in a vein of the arm.placed in a vein of the arm.
  • 21. Injuries of chestInjuries of chest  Simple/Closed PneumothoraxSimple/Closed Pneumothorax  Open PneumothoraxOpen Pneumothorax  Tension PneumothoraxTension Pneumothorax  Flail ChestFlail Chest  Cardiac TamponadeCardiac Tamponade  Traumatic Aortic RuptureTraumatic Aortic Rupture  Traumatic AsphyxiaTraumatic Asphyxia  Diaphragmatic RuptureDiaphragmatic Rupture
  • 22. 1. Simple/Closed1. Simple/Closed PneumothoraxPneumothorax o Accumulation of air in the pleural space without anAccumulation of air in the pleural space without an apparent antecedent event.apparent antecedent event. o Caused by rupture of smallCaused by rupture of small blebs(small sac of the air ) on the visceral pleuralblebs(small sac of the air ) on the visceral pleural spacespace o Blunt trauma is mainBlunt trauma is main o May be spontaneousMay be spontaneous o Usually self correctingUsually self correcting
  • 23. S/S of Simple/ClosedS/S of Simple/Closed PneumothoraxPneumothorax  Pleuritic Chest PainPleuritic Chest Pain  DyspnoeaDyspnoea  Tachypnea ( ABNORMAL RAPIDTachypnea ( ABNORMAL RAPID BRATHING )BRATHING )  Decreased Breath Sounds onDecreased Breath Sounds on Affected SideAffected Side  Hypertymphany to percussionHypertymphany to percussion ( like sound heard over air filled( like sound heard over air filled structure during the abdominalstructure during the abdominal examination
  • 24. Treatment for Simple/ClosedTreatment for Simple/Closed PneumothoraxPneumothorax  ABC’s with C-spine controlABC’s with C-spine control  Administer high concentration of oxygen to treatAdminister high concentration of oxygen to treat hypoxiahypoxia  Remove clothing to assess injuryRemove clothing to assess injury  Insert chest tube with connection to suction toInsert chest tube with connection to suction to remove remaining air and fluid / water sealremove remaining air and fluid / water seal drainagedrainage  Constant monitoringConstant monitoring  Opening is plugged to align it with gauzeOpening is plugged to align it with gauze impregnated with petroleum. A pressure dressingimpregnated with petroleum. A pressure dressing is applied and secured with a circumferential strapis applied and secured with a circumferential strap  Give semi- fowlers position or on injured siteGive semi- fowlers position or on injured site  Administer AntibioticsAdminister Antibiotics
  • 25. Ongoing monitoringOngoing monitoring  Vital signsVital signs  Level of consciousnessLevel of consciousness  Oxygen saturationOxygen saturation  Cardiac rhythmCardiac rhythm  Respiratory statusRespiratory status  Urinary outputUrinary output
  • 26. 2. Open Pneumothorax2. Open Pneumothorax  Opening in chest cavityOpening in chest cavity that allows air tothat allows air to enter pleural cavity.enter pleural cavity.  Causes the lung toCauses the lung to collapse due to increasedcollapse due to increased pressure in pleural cavity.pressure in pleural cavity. E.g. Stab/ gunshot wounds.E.g. Stab/ gunshot wounds.  Can be life threatening andCan be life threatening and can deteriorate rapidlycan deteriorate rapidly
  • 34. S/S of OpenS/S of Open PneumothoraxPneumothorax  DyspneaDyspnea  Sudden sharp painSudden sharp pain  Subcutaneous EmphysemaSubcutaneous Emphysema  Decreased lung sounds on affectedDecreased lung sounds on affected sideside  Red Bubbles on Exhalation fromRed Bubbles on Exhalation from wound ( a.k.a. Sucking chestwound ( a.k.a. Sucking chest wound)wound)
  • 35. SubcutaneousSubcutaneous EmphysemaEmphysema  Air collects in subcutaneous fat fromAir collects in subcutaneous fat from pressure of air in pleural cavitypressure of air in pleural cavity  Feels like rice crispies or bubble wrapFeels like rice crispies or bubble wrap  Can be seen from neck to groin areaCan be seen from neck to groin area
  • 37. Treatment for OpenTreatment for Open PneumothoraxPneumothorax  ABC’s with c-spine control asABC’s with c-spine control as indicatedindicated  High Flow oxygenHigh Flow oxygen  Listen for decreased breath sounds onListen for decreased breath sounds on affected sideaffected side  Apply occlusive dressing to woundApply occlusive dressing to wound  Notify HospitalNotify Hospital
  • 38. Occlusive/ Vented DressingOcclusive/ Vented Dressing  Allows air to escapeAllows air to escape from the vent andfrom the vent and decreases thedecreases the likelihood of tensionlikelihood of tension pneumothoraxpneumothorax developingdeveloping
  • 39. Occlusive DressingOcclusive Dressing  Asherman ChestAsherman Chest SealSeal
  • 40. 3. Tension3. Tension PneumothoraxPneumothorax  Air builds in pleural space with noAir builds in pleural space with no where for the air to escapewhere for the air to escape  Results in collapse of lung on affectedResults in collapse of lung on affected side that results in pressure onside that results in pressure on mediastium,the other lung, and greatmediastium,the other lung, and great vesselsvessels
  • 41. Tension PneumothoraxTension Pneumothorax Each time we inhale, the lung collapses further. There is no place for the air to escape..
  • 42. Tension PneumothoraxTension Pneumothorax Each time we inhale, the lung collapses further. There is no place for the air to escape..
  • 43. Tension PneumothoraxTension Pneumothorax Heart is being compressed The trachea is pushed to the good side
  • 44. S/S of TensionS/S of Tension PneumothoraxPneumothorax  Anxiety/RestlessneAnxiety/Restlessne ssss  Severe DyspneaSevere Dyspnea  Absent BreathAbsent Breath sounds on affectedsounds on affected sideside  TachypneaTachypnea  TachycardiaTachycardia  Poor ColorPoor Color  Accessory MuscleAccessory Muscle UseUse  JVDJVD  Narrowing PulseNarrowing Pulse PressuresPressures  HypotensionHypotension  Tracheal DeviationTracheal Deviation (late if seen at all)(late if seen at all)
  • 45. TREATMENTTREATMENT  Monitor Cardiac RhythmMonitor Cardiac Rhythm  Establish IV access and Draw BloodEstablish IV access and Draw Blood SamplesSamples  Airway control including IntubationAirway control including Intubation  Needle Decompression of AffectedNeedle Decompression of Affected SideSide
  • 46. Needle DecompressionNeedle Decompression  Locate 2-3 Intercostals space midclavicularLocate 2-3 Intercostals space midclavicular lineline  Cleanse area using aseptic techniqueCleanse area using aseptic technique  Insert catheter ( 14g or larger) at least 3” inInsert catheter ( 14g or larger) at least 3” in length over the top of the 3length over the top of the 3rdrd rib( nerve,rib( nerve, artery, vein lie along bottom of rib)artery, vein lie along bottom of rib)  Remove Stylette ( a flexible metallic rodRemove Stylette ( a flexible metallic rod inserted in the lumen of a flexible catheter )inserted in the lumen of a flexible catheter ) and listen for rush of airand listen for rush of air  Place Flutter valve over catheterPlace Flutter valve over catheter  Reassess for ImprovementReassess for Improvement
  • 48. 4, Hemothorax4, Hemothorax  Occurs when pleural space fills withOccurs when pleural space fills with bloodblood  Usually occurs due to lacerated bloodUsually occurs due to lacerated blood vessel in thoraxvessel in thorax  As blood increases, it puts pressureAs blood increases, it puts pressure on heart and other vessels in cheston heart and other vessels in chest cavitycavity  Each Lung can hold 1.5 liters of bloodEach Lung can hold 1.5 liters of blood
  • 55. HemothoraxHemothorax Lots of blood vessels Where does the blood come from.
  • 56. S/S of HemothoraxS/S of Hemothorax  Anxiety/RestlessnessAnxiety/Restlessness  TachypneaTachypnea  Signs of ShockSigns of Shock  Frothy, Bloody SputumFrothy, Bloody Sputum  Diminished Breath Sounds on AffectedDiminished Breath Sounds on Affected SideSide  TachycardiaTachycardia  Flat Neck VeinsFlat Neck Veins
  • 57. Treatment forTreatment for HemothoraxHemothorax  ABC’s with c-spine control asABC’s with c-spine control as indicatedindicated  Secure Airway assist ventilation ifSecure Airway assist ventilation if necessarynecessary  General Shock Care due to Blood lossGeneral Shock Care due to Blood loss  Consider Left Lateral RecumbentConsider Left Lateral Recumbent position if not contraindicatedposition if not contraindicated  RAPID TRANSPORTRAPID TRANSPORT  Contact HospitalContact Hospital
  • 58. 5. Flail Chest5. Flail Chest The breaking of 2The breaking of 2 or more ribs in 2or more ribs in 2 or more placesor more places
  • 60. S/S of Flail ChestS/S of Flail Chest  Shortness of Breath, respiratoryShortness of Breath, respiratory distress, Pneumothoraxdistress, Pneumothorax  Paradoxical MovementParadoxical Movement  Bruising/SwellingBruising/Swelling  Crepitus( Grinding of bone ends onCrepitus( Grinding of bone ends on palpation)palpation)  HypotensionHypotension
  • 61. Treatment of Flail ChestTreatment of Flail Chest  Flail Chest is a True EmergencyFlail Chest is a True Emergency  Ensure airwayEnsure airway  Administer oxygenAdminister oxygen  Assist ventilation. Chest decompression is doneAssist ventilation. Chest decompression is done for pneumothorax.for pneumothorax.  Establish I/V lineEstablish I/V line  Restrict fluid intake, prescribe corticosteroids andRestrict fluid intake, prescribe corticosteroids and albumin to treat pulmonary contusionalbumin to treat pulmonary contusion  Prepare for operative stabilization of chest wallPrepare for operative stabilization of chest wall
  • 62. Bulky Dressing for splintBulky Dressing for splint of Flail Chestof Flail Chest  Use TraumaUse Trauma bandage andbandage and TriangularTriangular Bandages to splintBandages to splint ribs.ribs.  Can also place aCan also place a bag of D5W onbag of D5W on area and tapearea and tape down. (The onlydown. (The only good use of D5W Igood use of D5W I can find)can find)
  • 63. 6. Pericardial6. Pericardial TamponadeTamponade Blood and fluidsBlood and fluids leak into theleak into the pericardial sacpericardial sac which surrounds thewhich surrounds the heart.heart. As the pericardialAs the pericardial sac fills, it causessac fills, it causes the sac to expandthe sac to expand until it cannotuntil it cannot expand anymoreexpand anymorepericardial sac
  • 64. Pericardial TamponadePericardial Tamponade Once theOnce the pericardial sacpericardial sac can’t expandcan’t expand anymore, theanymore, the fluid starts puttingfluid starts putting pressure on thepressure on the heartheart Now the heartNow the heart can’t fully expandcan’t fully expand and can’t pumpand can’t pump effectively.effectively.
  • 65. Pericardial TamponadePericardial Tamponade With poor pumpingWith poor pumping the blood pressurethe blood pressure starts to drop.starts to drop. The heart rate startsThe heart rate starts to increase toto increase to compensate but iscompensate but is unableunable The patient’s level ofThe patient’s level of conscious drops, andconscious drops, and eventually the patienteventually the patient goes in cardiac arrestgoes in cardiac arrest
  • 66. pericardial tamponadepericardial tamponade ,, is when fluid inis when fluid in the the pericardiumpericardium (the sac (the sac around the heart) builds up andaround the heart) builds up and results in compression of theresults in compression of the heart. .heart. .
  • 67. S/S of PericardialS/S of Pericardial TamponadeTamponade  Distended Neck VeinsDistended Neck Veins  Increased Heart RateIncreased Heart Rate  Respiratory Rate increases, cyanosisRespiratory Rate increases, cyanosis  Anxious, confusedAnxious, confused  Muffled heart soundMuffled heart sound  Hypotension, pulses paradoxesHypotension, pulses paradoxes  Shock, DeathShock, Death
  • 68. Treatment of PericardialTreatment of Pericardial TamponadeTamponade  Check for ABCCheck for ABC  High Flow oxygen which may includeHigh Flow oxygen which may include BVMBVM  Treat S/S of shockTreat S/S of shock  Assist with pericardiocentesisAssist with pericardiocentesis  Prepare for emergency thoracotomyPrepare for emergency thoracotomy
  • 69. TreatmentTreatment  Cardiac MonitorCardiac Monitor  Large Bore IV accessLarge Bore IV access  Perform pericardiocentesisPerform pericardiocentesis
  • 70. PericardiocentesisPericardiocentesis  Using aseptic technique, Insert at least needle atUsing aseptic technique, Insert at least needle at the angle of the Xiphoid Cartilage at the 7the angle of the Xiphoid Cartilage at the 7thth ribrib  Advance needle at 45 degree towards the clavicleAdvance needle at 45 degree towards the clavicle while aspirating syringe till blood return is seenwhile aspirating syringe till blood return is seen  Continue to Aspirate till syringe is full then discardContinue to Aspirate till syringe is full then discard blood and attempt again till signs of no more bloodblood and attempt again till signs of no more blood  Closely monitor patient due to small about of bloodClosely monitor patient due to small about of blood aspirated can cause a rapid change in bloodaspirated can cause a rapid change in blood pressurepressure
  • 71. 7. Traumatic Aortic7. Traumatic Aortic RuptureRupture The heart, more or less, just hangs from the aortic arch Much like a big pendulum. If enough motion is placed on the heart (i.e.. Deceleration From a motor vehicle accident, striking a tree while skiing etc) the heart may tear away from the aorta.
  • 72. Traumatic Aortic RuptureTraumatic Aortic Rupture The chances of survival are very slim and are based on the degree of the tear. If there is just a small tear then the patient may survive. If the aorta is completely transected then the patient will die instantaneously
  • 73. S/S Of Traumatic AorticS/S Of Traumatic Aortic RuptureRupture  Burning or Tearing Sensation in chestBurning or Tearing Sensation in chest or shoulder bladesor shoulder blades  Rapidly dropping Blood PressureRapidly dropping Blood Pressure  Pulse Rapidly IncreasingPulse Rapidly Increasing  Decreased or loss of pulse or b/p onDecreased or loss of pulse or b/p on left side compared to right sideleft side compared to right side  Rapid Loss of ConsciousnessRapid Loss of Consciousness
  • 74. TreatmentTreatment  Monitor Cardiac RhythmMonitor Cardiac Rhythm  Large Bore IV therapy probably 2 andLarge Bore IV therapy probably 2 and draw blood samplesdraw blood samples  Airway management that may includeAirway management that may include IntubationIntubation
  • 75. 8. Traumatic Asphyxia8. Traumatic Asphyxia  Results from sudden compressionResults from sudden compression injury to chest cavityinjury to chest cavity  Can cause massive rupture of VesselsCan cause massive rupture of Vessels and organs of chest cavityand organs of chest cavity  Ultimately DeathUltimately Death
  • 76. S/S of TraumaticS/S of Traumatic AsphyxiaAsphyxia  Severe DyspneaSevere Dyspnea  Distended Neck VeinsDistended Neck Veins  Bulging, Blood shot eyesBulging, Blood shot eyes  Swollen Tounge with cyanotic lipsSwollen Tounge with cyanotic lips  Reddish-purple discoloration of faceReddish-purple discoloration of face and neckand neck  PetechiaePetechiae
  • 77. TreatmentTreatment  Cardiac MonitorCardiac Monitor  Establish IV Access and draw bloodEstablish IV Access and draw blood samplessamples  Airway control including IntubationAirway control including Intubation  Rapid transportRapid transport
  • 78. 9. Diaphragmatic9. Diaphragmatic RuptureRupture  A tear in the Diaphragm that allowsA tear in the Diaphragm that allows the abdominal organs enter the chestthe abdominal organs enter the chest cavitycavity  More common on Left side due to liverMore common on Left side due to liver helps protect the right side ofhelps protect the right side of diaphragmdiaphragm  Associated with multipile injuryAssociated with multipile injury patientspatients
  • 80. S/S of DiaphragmaticS/S of Diaphragmatic RuptureRupture  Abdominal PainAbdominal Pain  Shortness of AirShortness of Air  Decreased Breath Sounds on side ofDecreased Breath Sounds on side of rupturerupture  Bowel Sounds heard in chest cavityBowel Sounds heard in chest cavity
  • 81. TreatmentTreatment  Cardiac MonitorCardiac Monitor  Establish IV access and draw bloodEstablish IV access and draw blood samplessamples  Airway management including IntubationAirway management including Intubation  Observe for Pneumothorax due toObserve for Pneumothorax due to compression on lung by abdominal contentscompression on lung by abdominal contents  Possible insertion of NG tube to helpPossible insertion of NG tube to help decompress the stomach to relieve pressuredecompress the stomach to relieve pressure
  • 82. Management of patients withManagement of patients with Thoracic TraumaThoracic Trauma  The treatment of polytraumatized patient mustThe treatment of polytraumatized patient must follow a certain protocol which includes.follow a certain protocol which includes. – Adequate oxygenation.Adequate oxygenation. – Fluid replacement.Fluid replacement. – Surgical intervention.Surgical intervention. – Treatment of septic complications.Treatment of septic complications. – Adequate caloric and substrate supplementation.Adequate caloric and substrate supplementation. – Prevention of stress bleeding.Prevention of stress bleeding. – Finally, be alert of possible complication (CNS, ARDS,Finally, be alert of possible complication (CNS, ARDS, hepatic, renal, coagulation disorders, sepsis.hepatic, renal, coagulation disorders, sepsis.
  • 83. RIB FRACTURE:RIB FRACTURE:  SIGN AND SYMPTOMS:  SEVERE PAIN, TENDERNESSSEVERE PAIN, TENDERNESS  MUSCLE SPASM WHICH AGGRAVATEMUSCLE SPASM WHICH AGGRAVATE WITH COUGHING , DEEP BREATHINGWITH COUGHING , DEEP BREATHING AND MOTIONAND MOTION  CRACKLING SOUND WITH GRATINGCRACKLING SOUND WITH GRATING  UNSTABLE RIB CAGE ON PALPATIONUNSTABLE RIB CAGE ON PALPATION
  • 84. TREATMENTTREATMENT  ENSURE AIRWAY AND ADMINISTERENSURE AIRWAY AND ADMINISTER OXYGENOXYGEN  Stabilize with hand followed by applicationStabilize with hand followed by application of large pieces of tape horizontal acrossof large pieces of tape horizontal across the flail segmentthe flail segment  GIVE ANALGESICGIVE ANALGESIC  ENCOURAGE FOR DEEP BREATHINGENCOURAGE FOR DEEP BREATHING  MAINTAIN PATENT I/V LINEMAINTAIN PATENT I/V LINE
  • 85. ASSESSMENT:ASSESSMENT:  A-A- AIRWAY MAINTENANCE WITHAIRWAY MAINTENANCE WITH CERVICAL SPINE PROTECTIONCERVICAL SPINE PROTECTION  B-B- BREATHING AND VENTILATIONBREATHING AND VENTILATION  C-C- CIRCULATION WITH HEMORRHAGECIRCULATION WITH HEMORRHAGE CONTROLCONTROL  D-D- DISABILITY, NEUROLOGICALDISABILITY, NEUROLOGICAL STATUSSTATUS  E-E- EXPOSURE/ ENVIRONMENTALEXPOSURE/ ENVIRONMENTAL CONTROL, PREVENT HYPOTHERMIACONTROL, PREVENT HYPOTHERMIA
  • 86. NURSING PROCESSNURSING PROCESS  INEFFECTIVE BREATHING PATTERN RELATEDINEFFECTIVE BREATHING PATTERN RELATED TO CHEST INJURYTO CHEST INJURY  RISK FOR DEFICIENT FLUID VOLUME RELATEDRISK FOR DEFICIENT FLUID VOLUME RELATED TO CHEST DRAINAGE AND BLOOD LOSSTO CHEST DRAINAGE AND BLOOD LOSS  ACUTE PAIN RELATED TO CHEST INJURY ANDACUTE PAIN RELATED TO CHEST INJURY AND PRESENCE OF DRAINAGE TUBES IN THE CHESTPRESENCE OF DRAINAGE TUBES IN THE CHEST  IMPAIRED PHYSICAL MOBILITY RELATED TOIMPAIRED PHYSICAL MOBILITY RELATED TO PAIN, MUSCLE INJURYPAIN, MUSCLE INJURY  RISK FOR INEFFECTIVE INDIVIDUAL COPINGRISK FOR INEFFECTIVE INDIVIDUAL COPING RELATED TORELATED TO TEMPORARY DEPENDENCE AND LOSS OF FULLTEMPORARY DEPENDENCE AND LOSS OF FULL RESPIRATORY FUNCTIONRESPIRATORY FUNCTION
  • 87. COMPLICATIONCOMPLICATION  ASPIRATIONASPIRATION  ATELECTESIS ( collapse or closure ofATELECTESIS ( collapse or closure of a lung )a lung )  INFECTIONINFECTION  PNEUMONIAPNEUMONIA  RESPIRARATORY FAILURERESPIRARATORY FAILURE =inadequate gas exchange by the=inadequate gas exchange by the respiratory systemrespiratory system
  • 88. SummarySummary Chest Injuries are common and often lifeChest Injuries are common and often life threatening in trauma patients. So, Rapidthreatening in trauma patients. So, Rapid identification and treatment of these patients isidentification and treatment of these patients is paramount to patient survival. Airwayparamount to patient survival. Airway management is very important and aggressivemanagement is very important and aggressive management is sometimes needed for propermanagement is sometimes needed for proper management of most chest injuries.management of most chest injuries.