Chest Trauma - Critical Care Nursing PDF

lOMoARcPSD|29850191 Chest trauma - Critical Care Nursing Critical Care Nursing (‫)اهنب ةعماج‬ Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Tendai Mpezeni ([email protected]) ...

lOMoARcPSD|29850191 Chest trauma - Critical Care Nursing Critical Care Nursing (‫)اهنب ةعماج‬ Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Tendai Mpezeni ([email protected])  lOMoARcPSD|29850191 Emergency nursing Chest trauma Intended Learning Outcomes: By the end of the subject, students should be able to: a) knowledge and understanding a.1- list different types of chest truma a.2- mention symptoms that may help identify different types of chest truma a.3- describe management of different types of chest trauma a.4 list mechanism of chest trauma b) intellectual skills b.1- Compare between pneumothorax and hemothorax b.2- Formulate laboratory and diagnostic finding of different types of chest trauma. C) professional and practical skills c.1- Implement medical emergency care for each type Definition Traumatic injuries to the chest contribute to 75% of all traumatic. Thoracic injuries range from simple rib fractures to complex life- threatening rupture of organs. Mechanisms of injuries causing chest trauma are :  Blunt trauma occurs when the chest strikes or is struck by an object.as( Motor vehicle accident ,Pedestrian accident ,Fall, Crush injury)  Penetrating trauma is an open injury in which a foreign body Impales or passes through the body tissues, creating an open wound.as (Knife, Gunshot, Stick, Arrow) Types of chest truam I. Rib fracture: Fracture of one or more ribs Possibly resulting in severe damage to underlying structures( Lungs , Sbclavian artery (SCA),Subclavian vein (SCV)) Causes 1. Eighty-five percent of patients with blunt chest trauma experience rib fractures 2. Associated with motor vehicle crashes (MVCs), assaults, and falls 11 Downloaded by Tendai Mpezeni ([email protected])  lOMoARcPSD|29850191 Emergency nursing Manifestation 1. Pain, worsening with breathing, coughing, movement, and on palpation 2. Shallow respirations 3. Splinting of region 4. Crepitus 5. Decreased breath sounds on the affected side Laboratory/Diagnostic findings 1. Chest x-ray may reveal fracture, atelectasis 2. Arterial blood gas analysis (ABGs) may reveal respiratory acidosis if the patient is hypo ventilating c. Also, hypoxia may be observed (PaO2, less than 90 mmHg) if severe pulmonary contusion is present 3. CBC if hemothorax is suspected E. Management 1. Rule out underlying structural damage (e.g., lacerated SCA or SCV, pneumothoraxjlacerated liver or spleen) by ordering arteriography, x-rays, CT scan 2. Pain medications such as aspirin, acetaminophen, and NSAIDs (e.g., Ibuprofen, 400-600 mg 4 times a day) 3. Aggressive pulmonary therapy, such as Turn, Cough, Deep Breathe, chest physiotherapy should be used on non-affected side, along with incentive spirometry 4. Monitor oxygen saturation; consider giving O2 at 2 L per nasal cannula, with oxygen saturation (SaO2) maintained at above 92 II. Flail chest: Fracture of two or more adjacent ribs in two or more places with loss of chest wall stability Cause: Most serious chest wall injury, Caused by blunt force/trauma Manifestation 1. Pain 2. Shortness of breath 3. Paradoxical chest wall movement-inspiration/expiration 12 Downloaded by Tendai Mpezeni ([email protected])  lOMoARcPSD|29850191 Emergency nursing 4. Shallow respirations 5. Tachypnea 6. Decreased level of consciousness (LOC) related to hypoxia 7. Cyanosis 8. Tachycardia 9. Splinting of chest wall 10. Crepitus 11. Decreased breath sounds on affected side Laboratory/Diagnostic findings 1. ABGs: hypoxia, possible respiratory acidosis 2. Chest x-ray: reveals rib fractures Management 1. Administer O2 correct possible respiratory acidosis, and consider ventilatory support with positive end-expiratory pressure (PEEP) and pressure support 2. Administer crystalloids, such as lactated Ringer's solution 3. Consider supporting/stabilizing flail segment with sandbags. 4. Pain medications Morphine sulfate 5. If lung contusion occurs, the patient may require long-term ventilation. III.Collapsed lung:  types A. Pneumothorax : Air in pleural space causing complete or partial collapse of the lung B. Hemothorax : Occurs when blood accumulates in the pleural space C. Open pneumothdrax :referred to as "sucking chest wound" , Air flows form atmosphere to pleural space and back again or Can lead to tension pneumothorax if covered with an occlusive dressing.caused by penetrating trauma, such as gunshot wounds or knife wounds D. Tension pneumqthorax : Collapse of the lung caused by one-way air flow into the pleural space that does not escape. The increased air in the pleural space shifts organs and increases intra thoracic pressure as heart 13 Downloaded by Tendai Mpezeni ([email protected])  lOMoARcPSD|29850191 Emergency nursing Manifestation 1. Respiratory distress 2. Hypoxia 3. Tachypnea 4. Decreased LOC 5. Hypotension 6. Cyanosis 7. Tachycardia 8. Shallow respirations 9. Chest pain 10. Decreased or absent breath sounds on affected side 11. Deviation of the trachea to the non-affected side 12.Tension pneumothorax may cause severe respiratory distress, leading to circulatory collapse (i.e., decreased cardiac output, decreased blood pressure) Laboratory/Diagnostic findings 1. ABGs may reveal respiratory acidosis 2. Chest x-ray reveals collapsed lung and possible mediastina shift 3. ECG may show heart strain Management 1. Smaller than 15% to 20% pneumothorax requires only observation; chest tube at fourth to fifth intercostal space (ICS), midaxillary line (MAL) as needed 2. If tension pneumothorax, rapid insertion of large-bore (14- to 16- gauge) needle into the second ICS, mid clavicular line of the affected side 3. Chest tube insertion to low wall suction (-20 cm) 4. Consider mechanical ventilation with PEEP 5. Open pneumothorax: Apply a dressing, leading one side untapped to allow air to escape 6. Massive hemothorax: Fluid resuscitation with lactated Ringer's solution should be considered prior to thoracotomy owing to loss of tamponed effect 14 Downloaded by Tendai Mpezeni ([email protected])  lOMoARcPSD|29850191 Emergency nursing IV. Cardiac tamponed: Blood rapidly collects in pericardial sac, compresses myocardium because the pericardium does not stretch, and prevents ventricles from filling. Manifestation: Muffled, distant heart sounds, hypotension, neck vein distention, increased central venous pressure Medical emergency: pericardiocentesis with surgical repair as appropriate V. Aortic rupture: An interruption of the wall of the aorta caused by blunt traumatic deceleration Manifestation 1. Shortness of breath 2. Weakness 3. Blood pressure and pulse amplitude are greater in upper extremities. 4. Chest or back pain 5. Circulatory collapse Laboratory/diagnostic findings: Chest x-ray may reveal a widened mediastinum Management 1. Thoracotomy to repair the rupture with cardio pulmonary bypass 2. Adequate fluid as crystalloids (e.g., normal saline, Ringer's lactate solution) 3. Packed red blood cells 4. Consider nitroprusside (Nitride), 0.5-8 meg/kg/minute to maintain systolic blood pressure at below 140 mmHg until patient can be taken to surgery 5. Mechanical ventilation 15 Downloaded by Tendai Mpezeni ([email protected])