CHEST TRAUMA

Jeremy G. Tellain BSN4-1

CHEST TRAUMA
Approximately a quarter of deaths due to trauma are attributed to thoracic injury. Immediate deaths are essentially due to major disruption of the heart or of great vessels.

Early deaths due to thoracic trauma include airway obstruction, cardiac tamponade or aspiration.

Classification of Chest Trauma:

Blunt Trauma results from sudden compression or positive pressure inflicted to the chest wall.

 Penetrating Trauma occurs when foreign object penetrates the chest wall.

Blunt Chest Trauma

RIB FRACTURES - Fractured ribs may occur at the point of impact and damage to the underlying lung may produce lung bruising or puncture. - Commonly a result of crushing chest injuries

Assessment
- Severe Pain - Muscle spasm - Tenderness - Subcutaneous Crepitus - Shallow Respirations - Reluctance to move - Client splints chest

Management
Rest Ice Compress then Local Heat Analgesia Splint the chest during coughing or deep breathing

FLAIL CHEST
The unstable segment moves separately and in an opposite direction from the rest of the thoracic cage during the respiration cycle

Assessment
Paradoxical respirations Severe chest pain Dyspnea/ Tachypnea Cyanosis Tachycardia

Management
High Fowlers position Humidified O2 Analgesia Coughing & deep breathing Prepare for intubation with mechanical ventilation with positive endexpiratory pressure ( PEEP ) for severe respiratory failure

Penetrating Chest Trauma

Pneumothorax - Accumulation of atmospheric air in the pleural space - may lead to lung collapse

Types of Pneumothorax
1. Spontaneous Pneumothorax occurs when air enters the pleural space through a breach of either the parietal or visceral pleura.

2. Open Pneumothorax

occurs when air escapes from a laceration in the lung itself and enters the pleural space or enters the pleural space through a wound in the chest wall.

3. Tension Pneumothorax

occurs when air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall.

Assessment

Dyspnea Tachycardia Tachypnea Sharp chest pain

Absent breathe sound Sucking sound Cyanosis

Management
1. Apply dressing over an open chest wound 2. O2 as Rx 3. High Fowlers 4. Chest tube placement - Monitor for chest tube system - Monitor for subcutaneous emphysema Chest Tube Drainage System - returns (-) pressure to the intra-pleural space - remove abnormal accumulation of air & fluids serves as lungs while healing is going on

Hemothorax
A condition wherein a certain amount of blood is trapped between the pleural cavity between the lungs and the chest walls. It is usually caused by a chest trauma, a blood clotting defect or chest injuries The best to treat hemothorax is to remove the trapped blood from the pleural cavity through an inserted tube.

CARDIAC TAMPONADE
It is compression of the heart resulting from fluid or blood within the pericardial sac. Usually caused by blunt or penetrating trauma to the chest.

SUBCUTANEOUS EMPHYSEMA
Subcutaneous emphysema is of itself usually not a serious complication. The subcutaneous air is spontaneously absorbed if the underlying air leak is treated or stops spontaneously.