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Chest trauma

Chest trauma. penetrating & blunt. Injuries to the Chest. Open Chest Injuries Caused by penetrating trauma Closed Chest Injuries Caused by blunt trauma. Failure of the chest to expand normally Rapid, weak pulse and low blood pressure Cyanosis around the lips or fingernails.

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Chest trauma

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  1. Chest trauma penetrating & blunt

  2. Injuries to the Chest • Open Chest Injuries • Caused by penetrating trauma • Closed Chest Injuries • Caused by blunt trauma

  3. Failure of the chest to expand normally Rapid, weak pulse and low blood pressure Cyanosis around the lips or fingernails Signs and Symptoms of Chest Injuries • Pain at the site of injury • Pain aggravated by increased breathing • Dyspnea • Hemoptysis

  4. Assessment of Chest Injuries • DCAP-BTLS • Chest wall movement • Paradoxical movement • Hemoptysis • Shock • Cyanosis

  5. Rib fracture • plueritic chest pain • A fractured rib may lacerate the surface of the lung. • Patients will avoid taking deep breaths and breathing will be rapid and shallow • may have contusion • often self splinted

  6. Rib Fracture • TX • high flow O2 • position of comfort

  7. Flail chest • 3 or more ribs broken in 2 or more places • Or when the sternum is fractured along with several ribs • free floating chest wall segment • paradoxical chest movement • dyspnea - poor tidal volume

  8. TX • High flow O2 • Immobilize flail segment • Supine • Rapid transport • Maintain the airway. • Provide respiratory support.

  9. Pneumothorax • Air accumulates in the pleural space. • Air enters through a hole in the chest wall. • The lung may collapse in a few seconds or a few hours. • An open or penetrating wound to the chest is called a sucking chest wound.

  10. S/S Pneumothorax • dyspnea • sharp chest pain • unequal breath sounds

  11. Care for Open Pneumothorax • Clear and manage the airway. • Provide oxygen. • Seal an open wound with an occlusive dressing. • Tape down all four sides or create a flutter valve. • Watch for Tension Pneumothorax

  12. Occlusive Dressing

  13. Spontaneous Pneumothorax • Some people are born with or develop weak areas on the surface of the lungs • Area can rupture spontaneously • Suspect in cases of sudden chest pain with no cause

  14. Tension Pneumothorax - Causes • Sealing all four sides of the dressing on a sucking chest wound. • Fractured rib puncturing the lung or bronchus. • Spontaneous pneumothorax.

  15. S/S Tension pneumothorax • Progressive dyspnea • Absent/decreased lung sounds (1 side) • JVD • Tracheal shift • Hypotension • Tachycardia

  16. RX • High flow O2 • Rapid transport • Unseal one side of occlusive dressing

  17. Hemothorax • Collection of blood in the pleural space • S/S of shock • Decreased breath sounds on affected side • hemopneumothorax

  18. Cardiac TamponadeAKA Pericardial Tamponade • Blood in the pericardium. • Weak pulse • Hypotension • Narrow pulse pressure • Jugular vein distention (JVD) • Dyspnea with equal breath sounds • RX – High flow O2 and rapid transport

  19. Myocardial contusion • Blunt Myocardial Injury • Chest pain • May have contusion over sternum • Irregular pulse • RX • High flow O2 • Rapid transport

  20. Pulmonary Contusions • Bruising of the lung • Develops over hours • Alveoli fill with blood • Provide oxygen and ventilatory support.

  21. Traumatic Asphyxia • Sudden, severe compression of chest • Results in JVD, cyanosis, and bleeding into the eyes • Provide supplemental oxygen and monitor vital signs. • Transport immediately.

  22. Impaled objects • stabilize with bulky dressings • use manual stabilization PRN • May remove if interfering with CPR

  23. Laceration of the Great Vessels • Superior/inferior vena cava, pulmonary arteries and veins, aorta • Can cause fatal hemorrhaging • TX: • CPR with BVM • Transport immediately

  24. Extra Credit Assignment • Read “Points to Ponder” Section at the end of Ch 27. Review the discussion question at the end of the scenario and prepare a response. • Worth up to 5 EC points depending on depth and appropriateness of answer. Due following class meeting. Late submissions not accepted.

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