Chest Trauma

Rib Fracture -chest pain, overlying tenderness, ecchymosis,

crepitus, swelling, and possible chest wall deformity, crepitus
goals of treatment: control pain and treat the injury.
 Sedation is used to relieve pain and to allow deep breathing and
coughing.
 intercostal nerve block
 ice over the fracture site.
 A chest binder

 3-6 weeks to heal

Flail chest - a
complication of blunt chest
trauma from a steering wheel
injury. three or more adjacent
ribs (multiple contiguous
ribs) are fractured in free-
floating rib segments.
 Severe chest pain, dob, paradoxical
movement
 Fix the rib with wire
 endotracheal intubation and
mechanical ventilation for severe flail
chest injury
 xray
Pulmonary contusion - damage to the lung tissues resulting in
hemorrhage and localized edema.
  tachypnea, tachycardia, chest pain, hypoxemia, and blood-tinged secretions
to more severe tachypnea, tachycardia, crackles, frank bleeding, severe
hypoxemia (cyanosis), and respiratory acidosis. 
 ABG, Pulse oximetry, xray
 Treatment : priorities include maintaining the airway, providing adequate
oxygenation, and controlling pain.
 adequate hydration via IV fluids and oral intake
 postural drainage, physiotherapy including coughing, and endotracheal
suctioning are used to remove the secretions.
 intercostal nerve blocks or by opioids. antimicrobial
 Supplemental oxygen is usually given by mask or cannula for 24 to 36 hours.
 Intubation and mechanical ventilation 
Pneumothorax
• Air collection of fluid
between pleural
space
• Sudden onset sharp
one sided chest pain,
SOB, respi distress
• Traumatic or non
traumatic, simple
Diagnostic evaluation
 Shadows on CXR, indicating a collapsed lung
 Increased carbon dioxide shown in ABG
 Low oxygen saturation on pulse oximetry
Management
 Bedrest.
 Supplemental oxygen if needed.
 Chest tube connected to suction to re-expand lung if
needed.
 Morphine for pain
Nursing management:
 Place patient in high Fowler’s or semi-Fowler’s
position to ease respiratory effort.
 Monitor chest tube for drainage amount and
characteristics of output. Note changes.
 Monitor vital signs for changes.
 Monitor respirations for rate, effort, use of accessory
muscles, skin color, and breath sounds.
 Teach turning, coughing, and deep-breathing exercises.
Cardiac tamponade
 Beck’s triad is a collection of three signs associated
with cardiac tamponade: distended neck veins, muffled
heart sounds, and hypotension.
 EKG, chest radiograph, and echocardiography
Treatment consists of the removal of pericardial
fluid to relieve the elevated intrapericardial pressure
and improve cardiac output. pericardiocentesis (needle
aspiration of the pericardial cavity)
 pericardial window (surgical creation of an opening)
 pericardectomy (resection of a portion or all of the
pericardium).