NURSING MANAGEMENT OF

CLIENTS WITH TRAUMA

TUELO TEMBWE
KETSHEPILE MATHOPA
 LEARNING OUTCOMDES
By the of the lesson learners should be able to:
Define chest trauma
 Classify chest injuries
Discuss main causes of chest trauma
Treatment of chest injuries
Nursing management of client under water seal drainage
 FUNCTION OF THE CHEST
provides protection for vital organs (heart , major vessels,
lungs and liver)
 WHY CHEST TRAUMA
The thoracic cavity contains three major anatomical systems: the
airway, lungs, and the cardiovascular system.
Any blunt or penetrating trauma can cause significant disruption
to each of these systems that can quickly prove to be life
threatening
Chest trauma can be fatal
Appropriate evaluation, resuscitation and stabilization any
patient with chest trauma is very vital
 CHEST TRAUMA
•Chest injury or chest trauma refers to any form of
physical injury to the chest including the rib cage,
heart, lungs, diaphragm and the lungs.
•Chest trauma are injuries to the chest area
anywhere between the neck and the abdomen.
 CAUSES OF INJURY
Blunt trauma; blunt force to the chest e.g. falls
Penetrating trauma: Projectile that enters chest causing
small or large hole e.g. gun shot, stab wound
Compression injury; chest is caught between two objects
and chest is compressed
PATHOPHYSIOLOGY
Rib fractures :1 and 2 rib fracture associated with
intrathoracic vesicular injuries-cough-pain
aggravated by respiratory movement and the patient
often splints while breathing
 CLASSIFICATION OF CHEST TRAUMA
Mainly classified into two:
Closed / blunt / non penetrating
Open /penetrating injuries
BLUNT/ CLOSED/ NON
PENETRATING
Damage to the structures within the chest cavity without
disrupting the chest integrity( blunt force to the chest)
Damage may be of a bruising or lacerating nature
 Associated with three mechanisms of injury ;
 car collisions (acceleration deceleration)- : most common
cause of chest trauma
 direct impact (falls)
 compression (chest caught between two objects and
compressed)
 BLUNT/ CLOSED/ NON
PENETRATING
Commonly caused by:
 car collisions, fall, sports , crush injury, assault with blunt
objects, blunt object striking the chest.
These injuries create a shearing force during which tissues,
organs or blood vessels are stretched beyond their capacity,
resulting in tear, leak or rupture
 OPEN /PENETRATING
Disrupt chest wall integrity and result in intrathoracic
pressure
Usually result from an open chest wound which permit
atmospheric air into the pleurae space and disrupting the
normal ventilation mechanism
 gunshots, stab wounds, arrow
 SPECIFIC CHEST
INJURIES
chest wall injuries : rib fractures and fail chest
pulmonary injuries; pulmonary contusion,
pneumothorax (open, simple/closed, tension,
hemothorax). Occurs from blunt chest trauma.
Cardiac injuries: cardiac tamponade, blunt cardiac
injury
 RIB FRACTURES
Most common type of chest trauma
fractures of rib 1and 2 are called ‘hallmark of severe trauma’
because these ribs are short, thick and well protected by the thoracic
musculature
It requires tremendous force to cause fracture of these bones
Rib 4 through to 9 are most often the fractured, because they are
less well protected by the chest muscles
May interfere with ventilation and may lacerate the underlying lung
RIB FRACTURE
 FLAIL CHEST
the breaking of two or more ribs in two or more places
a portion of the rib cage is separated from the rest of the
chest wall
occurs when the segment of the rib cage breaks under
extreme stress and becomes detached from the rest of the
chest wall
Two or more adjacent ribs broken in two or more places
Produces free floating chest wall segment
Chest wall becomes unstable
FLAIL CHEST
 SIGNS AND SYMPTOMS
Shortness of breath
Paradoxical movement
Bruising/ swelling
Crepitus (Grinding of bones ends on palpitation )
 TREATMENT
Flail chest is a true emergency
ABCs with c-spine control as indicated
Pulmonary hygiene
To keep your lungs clear of secretions, to keep one from developing pneumonia, which is the
main complication of flail chest. Pulmonary hygiene is also known as chest physiotherapy and
may include:
Suctioning to remove secretions from your airways.
Bronchodilator therapy, or medications that open your airways.
Fluid monitoring. It’s important to have the right amount of fluid in your blood so your lungs
work correctly.
Proper positioning to improve breathing and lessen pain.
Continuous airway positive pressure (CPAP) or supplemental oxygen instead of mechanical
ventilation to help you breathe. You may have to be on a ventilator to help you breathe until the
trauma heals.
TX CONT…
Pain control:
intravenous (IV) medications, an epidural or intercostal pain blocks to relieve
your pain.
 PNEUMOTHORAX
A pneumothorax is a collection of air outside the lung but within
the pleural cavity.
the presence of air in the thoracic cavity where there should
normally be negative pressure to facilitate inspiration
It occurs when air accumulates between the parietal and visceral
pleura inside the chest
The air accumulation can apply pressure on the lung and make it
collapse.
Pneumothoraxes can be even further classified as simple, tension,
or open.
 SIMPLE / CLOSED PNEUMOTHORAX
 Opening in the lung tissue that leaks air into the chest
cavity
A simple pneumothorax does not shift the mediastinal
structures, as does a tension pneumothorax
 blunt trauma is the main cause
Usually self correcting
signs and symptoms include; chest pains, dyspnea,
tachypnea, decreased breath sounds in the affected side
 MANAGEMENT
ABCs with C-spine control
Airway assistance as needed
Cardiac monitor
Provide airway management which includes possible
intubation
Monitor for development of Tension pneumothorax
 OPEN PNEUMOTHORAX
An open pneumothorax also is known as a "sucking"
chest wound
Opening in the chest that allows air to enter pleural
cavity
 causes the lung to collapse due to increased pressure
in pleural cavity
 can be life threatening and can deteriorate rapidly
OPEN PNEUMOTHORAX
 SIGNS AND
SYMPTOMS
 Dyspnoea

 Sudden sharp pain

Decreased lung sounds on the affected side
Red bubbles on exhalation from wound
 TREATMENT OF OPEN
PNEUMOTHORAX
ABCs with c-spine control as indicated
high Flow oxygen
 listen for decreased breaths sounds on affected side
Apply dressing to wound
Monitor heart rhythm
Airway control that may include intubation
Monitor for tension pneumothorax
 TENSION PNEUMOTHORAX
 Air builds in pleural space with no where to escape
Results in collapsed lung on affected side that
results in pressure on mediastinum , the other lung
and great vessels
 lung collapses further with inhalation
 No place for the air to escape
The trachea is pushed to the good side
 Heart is being compressed
 TENSION
PNEUMOTHORAX
 SIGNS
 anxiety/restlessness
AND SYMPTOMS
Severe Dyspnoea
Absent breath sounds on affected side
Tachypnea
Tachycardia
Poor colour
Use of accessory muscles
Narrowing pulse pressures
Hypotension
Tracheal deviation
 TREATMENT
ABCs with c-spine as indicated High flow oxygen
High flow oxygen
Treat for signs of shock
Monitor cardiac rhythm
Establish IV access and draw blood samples
Airway control including intubation
 HEMOTHORAX
Pleural space filled with blood
Usually occurs due to lacerated blood
vessels in the thorax
As blood increases , it puts pressure on the
heart and other vessels in the chest cavity
HEMOTHORAX
 SIGNS AND SYMPTOMS
Anxiety/ restlessness
Tachypnea
Signs of shock
 Frothy , bloody sputum
Diminished breath sounds on affected side
Tachycardia
Flat neck veins
 TREATMENT
ABCs with c-spine control
Secure airway/ assist with ventilation
 general shock care due to blood loss
Monitor cardiac rhythm
Establish large bore IV
Draw blood samples
Airway management including intubation
Hemo pneumothorax; needle decompression
CARDIAC INJURIES: PERICARDIAL TAMPONADE
 PERICARDIAL
TAMPONADE
Also known as Cardiac Tamponade
blood and fluids leak into the sac which surrounds the heart
(pericardium fills with fluid especially blood)
As the pericardial sac fills, it causes the sac to expand until it
cannot expand anymore
Once the pericardial sac cannot expand anymore , the fluid starts
to put pressure on the heart
The heart cannot fully expand and cannot pump effectively
With poor pumping the blood pressure starts to drop
The heart rate starts to increase to compensate but is
unable
The patients level of conscious drops and eventually the
patient goes in cardiac arrest
SIGNS AND SYMPTOMS
Distended Neck Veins
Increased heart rate
Respiratory Rate increases
Poor skin colour
 Narrowing pulse pressures
Hypotension
Death
 TREATMENT
ABCs with spine control as indicated
High flow oxygen
Treat S/S of shock
Cardiac Monitor
PERICARDIOCENTESIS
procedure done to remove fluid that has built
up in the pericardium
PERICARDIOCENTESIS
 TRAUMATIC ASPHYXIA
Results from sudden compression injury to the
chest cavity
Can cause massive rupture of the vessels and
organs
Ultimately death
 S/S
Severe dyspnea
Distended neck veins
Bulging , blood shot eyes
Swollen Tongue with cyanotic lips
 Reddish-purple discoloration of face and neck
 TREATMENT
ABCs with c-spine control as indicated
High flow of oxygen Treat for shock
Care for associated injuries
Cardiac monitoring
Airway control including intubation
NURSING MANAGEMENT OF
CLIENT UNDER WATER SEAL
 UNDERWATER SEAL
A system that allows drainage of the pleural space using an airtight system to
maintain sub atmospheric intrapleural pressure; the underwater seal acts a one-
way valve
Chest drains also known as under water sealed drains (UWSD)
inserted to allow draining of the pleural spaces of air, blood or fluid, allowing
expansion of the lungs and restoration of negative pressure in the thoracic
cavity.
The underwater seal also prevents backflow of air or fluid into the pleural
cavity.
Appropriate chest drain management is required to maintain respiratory
function and haemodynamic stability.
drainage of pleural air, blood or other fluid to allow re-expansion of lung