2 nd annual rapid review 12.o3.12 care of patient with chest injuries
DESCRIPTION
2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES. Sujitha .E, Lecturer, Faculty of Nursing, Sri Ramachandra University, Porur. Chest cavity. Soft tissues Lungs Heart Great vessels diaphragm oesophagus. Bony areas. Ribs Sternum Clavicle Tracheo broncheal - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/1.jpg)
Sujitha .E,Lecturer,
Faculty of Nursing,Sri Ramachandra University, Porur
![Page 2: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/2.jpg)
Chest cavitySoft tissuesLungsHeartGreat vesselsdiaphragmoesophagus
![Page 3: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/3.jpg)
Bony areas
RibsSternumClavicleTracheo broncheal tree
![Page 4: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/4.jpg)
ClassificationBlunt injuries Penetrating injuries
![Page 5: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/5.jpg)
EtiologyMotor vehicle accidentsFall from heightViolenceIatrogenic
![Page 6: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/6.jpg)
Mechanisms involvedAcceleration forceDeceleration forceTransmission of blunt internal
force to force to structuresDirect traumaCompression
![Page 7: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/7.jpg)
Chest traumaChest wall injuriesSternal fracturesFlail chestPulmonary and
pleural injuriesTraumatic
asphyxiaTracheo bronchial
injuries
PneumothoraxHemothoraxMediastinal injuriescardiac injuriesGreat vessel
injuriesDiaphragmatic
injuriesOesophageal
injuries
![Page 8: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/8.jpg)
From history (King Tut 1341 BC – 1323 BC)
![Page 9: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/9.jpg)
Pulmonary injuries PneumothoraxCollection of air in the space between the parietal and visceral pleura
![Page 10: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/10.jpg)
Tension pneumothorax
An expanding collection of intra pleural air without communication with external environment
Clinical manifestationsDistended neck veinsHypotension/hypoperfusionAbsent breath sounds on affected sideTracheal deviation to contra lateral side
![Page 11: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/11.jpg)
ManagementImmediate needle aspiration14 gauge IV needle of length more
than 4.5 cm and catheter into pleural space through chest wall in MCL at second intercostal space(temporary measure)
Large bore chest tube thoracostomy
![Page 12: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/12.jpg)
![Page 13: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/13.jpg)
Open pneumothorax (sucking chest wound)A communication between the pleural space and surrounding atmospheric pressure
Respiration is the function of negative pressure inside the thoracic cavity , positive atmospheric pressure and elastic recoil of lungs
![Page 14: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/14.jpg)
PneumothoraxClinical manifestations•Air entry and breath sounds diminished in the affected side•Impaired chest wall motion
![Page 15: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/15.jpg)
PathophysiologyNegative intrapleural pressure during
inspiration
Air leak into the pleural cavity
Increased intra thoracic pressure
Reduced vital capacity and venous return
![Page 16: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/16.jpg)
PneumothoraxDiagnosisChest radiography(double pleural markings)UltrasoundManagementCover the wound with a three sided dressingAir can escape during expiration but do not
enter during inspiration(one way valve)Chest tube insertion
![Page 17: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/17.jpg)
Pneumothorax
![Page 18: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/18.jpg)
Open pneumothorax3-side dressing Asherman chest seal
![Page 19: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/19.jpg)
Massive hemothoraxAccumulation of at least 1500 ml or
two thirds of the available hemithorax in an adult
![Page 20: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/20.jpg)
HemothoraxLife threatening by three
mechanismsAcute hypovolemia causing
decreased preloadCollapsed lung promoting hypoxiaHemothorax compressing venacava impairing preload
![Page 21: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/21.jpg)
HemothoraxClinical manifestations Abnormal vital signs Dullness to percussion Diminished breath soundsDiagnosisPlain chest radiography completely
opacified hemithoraxUltrasonography-fluid between chest wall
and lung
![Page 22: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/22.jpg)
ManagementChest tube insertionCare of chest tubePosition-last hole 2.5-5 cm inside chest wallSuction chamber with 20-30 cm of waterNever clamp the tubesBottle at 1-2 ft lower than patient’s chestLeft in place for 24 hrs after leak has stopped
![Page 23: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/23.jpg)
![Page 24: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/24.jpg)
![Page 25: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/25.jpg)
Flail chestFree floating lung segment that is no
longer connected to the rest of the thorax
CauseSegmental rib fractures in two or
more locations of the same rib of three or more adjacent ribs
![Page 26: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/26.jpg)
Flail chestClinical manifestationsParadoxical inward movement of the involved portion of the chest wall during inspiration and outward movement during expiration
![Page 27: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/27.jpg)
Pathophysiology-flail chest
Decreased ventilatory efficiency
Increased work of breathing
Hypoxemia
Sudden respiratory arrest
![Page 28: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/28.jpg)
url.htm
![Page 29: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/29.jpg)
Management-Flail chest
AnalgesicsVentilator support
stabilization
![Page 30: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/30.jpg)
Diaphragmatic injuryOften unnoticed if not very big defectCauses referred shoulder painRespiratory distress (herniation of abdominal
contents into the thorax)DiagnosisDecreased breath soundsAuscultation of bowel sounds in the chestTension viscero thoraxBowel obstruction and strangulation
![Page 31: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/31.jpg)
Management- Repair of diaphragm
![Page 32: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/32.jpg)
Cardiac injuries
![Page 33: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/33.jpg)
Cardiac tamponadeAccumulation of blood in the pericardial
cavity under pressureCommon causes are gunshot wounds and
stabsClinical features Tachycardia Narrow pulse pressure Elevated CVP Hypotension
Becks triad
![Page 34: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/34.jpg)
Cardiac tamponade Pathophysiology
Elevated intra cardiac pressure
Decreased right and left ventricular filling
Decreased cardiac output
![Page 35: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/35.jpg)
Management-Pericardiocentesis
![Page 36: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/36.jpg)
Great vessel injuriesThe main vessels AortaBrachio cephalic
branchesPulmonary arteries
and veinsVenae cavaeThoracic duct
![Page 37: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/37.jpg)
Aortic injuryCommonly injured part is proximal descending aortaClinical manifestationsHypo tensionhypertension in upper extremity& hypotension in
lower extremitiesIntra capsular murmurs or bruitsDiagnosisChest radiographTEECHOAortography
![Page 38: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/38.jpg)
Aortic rupture
![Page 39: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/39.jpg)
ManagementPharmacologic control of heart rate and blood
pressure(around 60/mt and 100-120 mmHg systolic)
Hemodynamic monitoring (pul.catheter)SedativesAnalgesicsVasodilators (sodium nitroprusside)β –blockers (esmolol)Auto transfusionSurgical repair
![Page 40: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/40.jpg)
Nursing diagnosesAcute painFluid volume deficitDecreased cardiac outputInability to sustain spontaneous ventilation Ineffective breathing patternImpaired gas exchangeImpaired tissue perfusion
![Page 41: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/41.jpg)
![Page 42: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/42.jpg)
![Page 43: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/43.jpg)
Other investigationsCTBronchoscopyOesophagoscopyOesophagographyAngiography
![Page 44: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/44.jpg)
Airway management- Airway management- IndicationsIndications for mechanical ventilation for mechanical ventilationo Altered mental statusAltered mental statuso Excessive secretionsExcessive secretionso Associated face and neck injuriesAssociated face and neck injurieso Impending respiratory failureImpending respiratory failureo Cardiopulmonary collapseCardiopulmonary collapseo Significant co morbiditiesSignificant co morbiditieso Advanced ageAdvanced ageo ABG abnormalitiesABG abnormalities
![Page 45: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/45.jpg)
Fluid resuscitationGoal: to stabilize the intravascular volume sufficiently
to provide time to manage hemorrhageInsert at least two large bore IV catheters
Central/femoral/subclavian/IJV accessControl hemorrhage and then replaceConsider auto transfusion
![Page 46: 2 ND ANNUAL RAPID REVIEW 12.O3.12 CARE OF PATIENT WITH CHEST INJURIES](https://reader033.vdocuments.us/reader033/viewer/2022051518/56815d88550346895dcb91fc/html5/thumbnails/46.jpg)