33 hours ago · Introduction. Chest trauma is classified as blunt or penetrating, with blunt trauma being the cause of most thoracic injuries (90%). The main difference lies in the presence of an opening to the inner thorax in penetrating trauma, created by stabbing or gunshot wounds, which is absent in blunt chest trauma [].Blunt thoracic injuries are the third most common injury in … >> Go To The Portal
Areas of suspected trauma in the ribcage that give way to gentle pressure may indicate a "compound fracture" which predisposes patients to flail chest. Always palpate the sternum, as sternal fracture implies a high energy mechanism of injury.
Full Answer
The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, distension of the neck vein, profuse diaphoresis, and an increase of intrathoracic pressure. What is the priority procedure in this situation?
TEST-TAKING HINT: The test taker can use "chest trauma" or "pneumothorax" to help select the correct answer. Both of these words should cause the test taker to select "2" because unequal chest expansion would result from trauma. The client had a right-sided chest tube inserted two (2) hours ago for a pneumothorax.
Flail chest may occur as a complication of cardiopulmonary resuscitation. Hemothorax occurs as a result of blunt chest trauma or penetrating injuries. Pneumothorax may occur due to blunt chest trauma or in patients with chronic obstructive pulmonary disorder. A patient has episodes of ventricular tachycardia.
Which type of trauma indicates splinting of the chest as the treatment modality? Rib fracture Place in the correct order the physiological changes occurring in a patient with pulmonary contusion. - Hemorrhage and edema occur in and between the alveoli first, thereby reducing both lung movement and the area available for gas exchange.
Flail chest is identified using a chest x-ray. Doctors look for evidence in the condition of the ribs themselves, but some fractures are not easily seen. So they also look at the surrounding organs and structures. A punctured blood vessel or contusions on the lungs, for example, are solid indications of flail chest.
A computed tomography (CT) scan is the preferred test for identifying flail chest, as an X-ray may not identify all rib fractures. If a CT scan alone or in combination with an X-ray finds at least three ribs broke in two places, flail chest will be diagnosed.
Usually, when you have experienced an accident that is traumatic enough to cause flail chest, your lungs can be bruised as well (a condition called a pulmonary contusion). Other internal organs can have bruising or damage as well, and your doctor will likely assess these injuries too.
Initial treatment of flail chest includes supplemental oxygen, pain relief (intercostal nerve blocks, oral or intravenous narcotics, or an epidural blockade given as a continuous infusion), and physiotherapy. Fluid therapy must be carefully monitored to avoid pulmonary edema, and intensive care monitoring is advisable.
The concern about "mediastinal flutter" (the shift of the mediastinum with paradoxical diaphragm movement) does not appear to be merited. Pulmonary contusions are commonly associated with flail chest and that can lead to respiratory failure.
Pulmonary complications due to flail chest include pneumothorax, hemothorax, pulmonary contusion, pneumonia and atelectasis [4,6,9]. Although the incidence of hemo- or/and pneumothorax is often mentioned its effects on outcome are seldom noted.
(A) Flail chest occurs when multiple rib fractures result in a loss of stability of the chest wall. The loss of continuity with the remainder of the rib cage causes the flail segment to move paradoxically. (B) Pressure within the chest is negative during inspiration, causing the flail segment to retract.
The most common signs and symptoms are: pain in the chest that gets worse when laughing, coughing or sneezing. tenderness....Symptoms of a fractured rib are:extreme pain when breathing in.tenderness to the chest or back over the ribs.a 'crunchy' feeling under the skin.severe shortness of breath.
Flail chest refers to a type of injury that follows a blunt trauma to the chest. It happens when three or more ribs are each broken in more than one place, causing a segment of bone to detach from the chest wall.
In flail chest, which of the following occur? When a patient has severe flail chest, which of the following occurs? C. Four adjacent ribs.
Chest Trauma Assessment of the Skeletal System. The skeletal system has the most externally obvious signs of injury but also has the greatest number of areas to inspect. As such, it is beneficial to use a standardized approach which you can apply to every patient. These vital steps are to question, inspect, palpate, and re-assess.
Hypoperfusion is the most common condition that presents initially in the extremities--cyanosis, hypothermia, increased turgor, and diaphoresis are signs of hypoperfusion that are seen in the extremities. This could point to a major chest injury that is leading to severe blood loss.
By far, a change in the level of consciousness and changes in vital signs shortly following trauma are the earliest indicators of an underlying issue.
Stridor or severe wheezing may indicate accompany tracheal/bronchial collapse/rupture.
Watching for signs of injury such as abnormal movement, guarding, bruising, bleeding, and asymmetry. It is important to inspect all skin surfaces to look for hidden injuries, then turn a detailed focus to the abnormal areas brought up in the question step.
Finally, the presence of a pulsatile mass is concerning for an aneurysm, which can uncommonly result from acute trauma. CARDIAC: As above, distended neck veins may also signify direct cardiac damage. The other findings of cardiac damage are nonspecific. ECG and lab tests are required for rule out if cardiac trauma is suspected.
Four main mechanisms of injury are responsible for chest trauma: direct impact to the chest, thoracic compression, rapid acceleration/deceleration and blast injury. Injuries from a direct impactare usually less dangerous and affect mainly the soft tissues of the chest wall (haematomas, rubbings).
Thoracic injury overall is the third most common cause of trauma following injury to the head and extremities. Thoracic trauma has a high morbidity and mortality, accounting for approximately 25% of trauma-related deaths, second only to head trauma. More than 70% of cases of blunt thoracic trauma are due to motor vehicle collisions, ...
Type 1 Compression rupture injury (the most common type) is centrally located, can become very large and is produced by compression of the lung against the tracheobronchial tree. Type 2 Compression shear injury is produced when the lower lobes are suddenly squeezed against the spine.
Most blunt thoracic injuries are caused by motor vehicle crashes (MVC; 63–78%), with the remainder (10–17%) caused by falls from heights and a minority from blows from blunt objects or explosive devices [5].
Fractures of the first three ribs imply high-energy trauma that may be associated with injury of the brachial plexus or subclavian vessels. Fractures of the fourth up to the eighth ribs are the most common, while fractures of the last four ribs are usually associated with intra-abdominal injury.
The most common site of injury is the isthmus, corresponding to 90–95% of cases. Uncommon sites include the aortic root-ascending aorta, the aortic arch-branch vessels and the mid-distal descending aorta.
Aortic injuries have a high morbidity and mortality; 90% of the patients die at the trauma scene, while 90% of initial survivors die within 4 months if the injury is undetected and untreated [38]. In the remaining 20% of cases, aortic injury is caused by falls and pedestrian injuries.
Flail chest is a thoracic injury associated with fracture of ribs, and the patient will require positive pressure ventilation and intubation for effective treatment. Chylothorax is a thoracic injury and is characterized by the presence of lymph in the pleural space. Surgery and pleurodesis treats chylothorax.
In the case of traumatic hemothorax, the nurse should assist in the immediate insertion of a chest tube, which is required for evacuation of blood. This blood can be recovered and reinfused for a short time after the injury. Further assessment can be done later.
Reduced flow of lymphatic fluid. Chylothorax is a type of chest injury that is associated with accumulation of fluid in the pleural space. Octreotide acts like the natural hormone, somatostatin, which behaves as a vasoconstrictor and reduces the flow of lymphatic fluid into pleural space.
Cardiac tamponade is a type of lung injury that is manifested by the presence of blood in the pericardial space and compression of the myocardium. Spontaneous pneumothorax is a type of lung trauma that occurs due to rupture of blebs at the apex of the lung.
Observe for 24 hours prior to action. Assist the health care provider in inserting a chest tube. Assist the health care provider in inserting a chest tube. Hemothorax is an accumulation of blood in the pleural space resulting from injury to the chest wall, lung, blood vessels, diaphragm, or mediastinum.
When the left part of the chest is crushed, breathing is compromised and asymmetric excursion is seen. This information, along with the absence of breath sounds, is an indication of a left pneumothorax. The injury is located on the left side of the chest. Pulmonary embolism does not present with the given history.
The air leak was from the tube between points 3 and 4. The air leak was from the tube between points 3 and 4. Whenever the bubbling increases, the nurse should suspect an air leak. To look for the point of leak, the nurse should clamp the tube to the chest and see if it is from the patient's chest.
When a patient is diagnosed with pulmonary fibrosis, the nurse will teach the patient about the risk for poor oxygenation because of. a. too-rapid movement of blood flow through the pulmonary blood vessels. b. incomplete filling of the alveoli with air because of reduced respiratory ability.
A. Hyperthermia related to infectious illness. Because the patient has spiked a temperature and has a diagnosis of pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill, and her breathing pattern is within normal limits at 20 breaths per minute.
If the patient can take deep breaths, instruct them to do so 3-4 times before suctioning. a. while you do want to measure pulse oximetry if possible, it isn't critical to do so and doesn't prevent hypoxia... it identifies it. If the oxygen saturation falls below 90%, hypoxia is indicated.
Both of these words should cause the test taker to select "2" because unequal chest expansion would result from trauma.
The drain is properly filled with water and placed in an upright position below the patient's chest. The physician orders suction to the chest drain system.
The tube is milked to help dislodge a blood clot that may be blocking the chest tube causing no fluctuation (tidaling) in the water- seal compartment. The chest tube is never stripped, which creates a negative air pressure and would suck lung tissue into the chest tube. 4.
Subcutaneous emphysema is air under the skin, which is a common occurrence at the chest tube insertion site. TEST-TAKING HINT: The test taker should be careful with adjectives. In option "1" the word "low" makes it incorrect; in option "3," the word "strict" makes this option incorrect.