Chest_Trauma_Lecture - Chest Trauma Pathophysiology Chest...

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Chest Trauma Pathophysiology Chest is large exposed portion of body Houses the heart, lungs, great vessels etc. Injury can restrict the heart’s ability to pump Major dangers are internal bleeding and punctured organs Categories Blunt trauma- Sudden compression or positive pressure inflicted to the chest wall. Examples: Steering Wheel, Baseball Bat, Seat Belt Penetrating trauma- foreign object penetrates chest wall. Examples: Gun Shot, Knife Initial Assessment and Management Initial thorough history- Check the Airway First (ABC) Guidelines are followed developed by American College of Physicians Committee on Trauma Greater chance of survival if care given within 1 hour of injury In hospital Primary survey * Check for Collapsing of the Lung* If the trachea has deviated, all organs have probably deviated. ABCs (immobilize for spinal injuries). Check need for: Intubation Chest tube insertion Central line access Assess for hypovolemia (dec BP, Inc HR, Pallor) Listen for Heart Sounds Fluid resuscitation Blood Quick History 1 minute Assessment Pleural Space Injuries Pneumothorax Characterized by the accumulation of air in the pleural space . Can occur spontaneously Hemothorax Normally caused by Thoracic Surgery or trauma Characterized by the accumulation of blood in the pleural space . Empyema Accumulation of pus
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Traumatic Pneumothrorax - falling, being hit, gun shot, stabs, etc. Spontaneous Pneumothrorax Either of the above can cause a Tension Pneumothrorax (traumatic or spontaneous) - Central line insertion can cause Tension Pneumothorax. - Always need to get an X-ray after insertion of Central Line, Chest tube (to check placement, pneumothorax, or cardiac tamponade.) Spontaneous Pneumothorax (Simple) Rupture of a bleb on the lung surface allows air to enter pleural space from airways.- Blebs are often found in patient’s that have lung disease ( COPD/Emphysema) . Can occur spontaneously in previously healthy people. People with preexisting lung disease are at risk. Traumatic 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. Trauma to the chest wall or pleura disrupts the pleural membrane Types: Open (sucking chest wounds) When a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration. This is better because air flows in and out Closed- internal Hemothorax- Blood pools in the pleural space Clinical Manifestations Moderate Pneumo Sudden sharp pain on affected side Asymmetrical chest movement Diminished or absent breath sounds Restless, anxious Sucking sound if open Severe Pneumo All of the above plus Distended neck veins -
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This note was uploaded on 05/04/2008 for the course NURS 240 taught by Professor Harmon during the Spring '08 term at Lady of the Lake.

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Chest_Trauma_Lecture - Chest Trauma Pathophysiology Chest...

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