Ch 29: Chest Injuries
Explain the mechanics of ventilation in relation to chest injuries 1033-1034
If you change either the tidal volume or minute ventilation, you affect the amount of air moving through the system.
Describe the differences between an open and closed chest injury 1034-1035
Open: Object penetrates chest wall itself. Do not attempt to remove object. Closed: Skin is not broken. Generally caused by blunt trauma. Can cause rib/sternum/chest wall fractures, bruising of lungs and heart, damage to aorta, vital organs to be torn from attachment in chest cavity.
List the signs of chest injury 1035-1036
Pain at site of injury; localized pain; bruising to chest wall; crepitus on palpation; penetrating injury; dyspnea; hemoptysis; limited chest movement; rapid/weak pulse; low bp; cyanosis around lips/fingernails. Often have rapid and shallow respirations. Hurts to take deep breath. Pt may not be moving air. Auscultate several areas to assess breath sounds.
Describe the management of a pt with a suspected chest injury, including pneumothorax, hemothorax, cardiac tamponade, rib fractures, flail chest, pulmonary contusion, traumatic asphyxia, blunt myocardial injury, commotio cordis, and laceration of the great vessels 1041-1048
Pneumothorax: Air in the lungs. -Tension Pneumothorax: significant ongoing air accumulation in pleural space. Absent or diminished chest sounds. -Sucking chest wound: Open/penetrating wound to chest wall. Give O, then treat with flutter valve. -Simple Pneumothorax not resulting in major changes in pt's cardiac physiology (from blunt trauma that results in fractured ribs, hard to diagnose) Hemothorax: Blood in pleural space from bleeding: around rib cage, lung injury, lacerated great vessel. S&S- shock, decreased breath sounds on affected side. Treat by rapidly transporting, giving O. Cardiac tamponade: Protective membrane around heart fills with blood/fluid. Heart cannot adequately pump blood due to pressure. S&S- *Beck's Triad* Narrowing pulse pressure, JVD, muffled heart tones, altered mental status. Treat by supporting ventilations and rapidly transporting. Rib fractures: common in elderly. Fracture of one of upper four ribs is a sign of substantial MOI. Fractured rib may cause pneumothorax or hemothorax. S&S: localized tenderness and pain on breathing, rapid/shallow respirations, pt holding affected portion of rib cage. Treat by giving O, encouraging pt to deep breath once a minute. Flail chest: Multiple rib fractures; 3+ sequential ribs, fractures in 2+ places each; Creates unstable section- moves opposite of respiratory pattern. Treat by maintaining airway, providing respiratory support as needed, Tape bulky dressing against flail segment. Pulmonary contusion: Should be suspected in blunt chest trauma, rib fracture, flail chest. Pulmonary alveoli become filled with blood, leading to hypoxia. Treat by providing respiratory support and supplemental O, rapidly transporting. Traumatic asphyxia: Sudden, severe compression of chest- produces rapid increase in pressure. Characterized by distended neck veins, cyanosis of face/neck, hemorrhage in sclera of eye. Suggests underlying injury to heart and lungs. Treat by ventilating and giving O, monitoring vitals during transport. Blunt myocardial injury: Bruising to heart muscle. Heart may be unable to maintain bp. S&S: irregular pulse rate, chest pain/discomfort. Treat by carefully monitoring pulse, noting changes in bp. Commotio cordis: Injury from sudden, direct blow to chest during critical portion of heartbeat. Often results in immediate cardiac arrest. V fib responds to defib within first 2 minutes of injury. Laceration of great vessels: May result in rapidly fatal hemorrhage. Treat by ventilating as needed, transporting immediately, watching for shock, monitoring vitals.
