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Basic facts about chest trauma
- Thoracic injury – causes death in 20-25% of trauma victims
- Chest wall injury – 45% of thoracic traumas
- Examples: Blunt trauma, Penetrating trauma
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Pneumothorax
- Air in pleural space – collapsed lung
- Closed – no open wound
- Open – chest wall open, ie wound Stab, gunshot, surgical
- Tension Pneumo – air rapidly entering pleural space--> Tension on heart/vessels-->EMERGENCY!
- --treated with chest tube to Remove air/fluid from pleural space and encourage Re-expansion of lungs
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Hemothorax
- Blood in intrapleural space
- May be hemopneumothorax
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Rib fxr
- Most common chest trauma injury
- PAIN!!!
- --Shallow breathing
- --Atelectasis
- Multiple rib fx – unstable chest wall – Flail Chest (with inspiration, one side of chest will collapse instead of expand. Think asymetrical expansion)
- --aka Paradoxical movement to intact chest
- --Inadequate ventilation
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Pleural Effusion
- Fluid in the pleural space
- Sign of serious disease
- Transudative: noninflammatory conditions – accumulation of protein-poor, cell-poor fluid. Caused by 1. incr hydrostatic pressure of HF (most common); 2. decr oncotic pressure (hypoalbuminemia) from chronic liver or kidney dz.
- Exudative
- Empyema: contains pus. Pneumonia, TB, lung abscess, post op infection.
- Thoracentesis: diagnostic & therapeutic.
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Pulmonary Embolism (PE)
- Thrombus, air or fat, tumor blockage of pulmonary arteries
- Gains venous access then pulmonary circulation
- DVT, R heart, pelvic veins
- Mortality 30% without tx; 2-8% with tx.
- SnSs: pt may be purple from head to nipple level.
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Risk factors for PE
- Immobilization
- Surgery
- Obesity
- Advancing age
- Hypercoagulability
- Hx of thromboembolism
- Smoking + estrogen therapy
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SnSs of PE
- Common: anxiety, sudden dyspnea, tachypnea, tachycardia
- “Classic sx triad”: dyspnea, chest pain, hemoptysis (only 20% display these sx)
- Mild/mod hypoxemia – low PaCO2
- Cough, pleuritic CP, hemoptysis, crackles, fever, incr pulmonic heart sound (S3 & S4), mental status change
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Collaborative care of pt w/PE
- ABG
- O2 – cannula/intubation
- TDBC
- Vasopressors
- Diuretics
- Analgesia
- Anticoagulants
- Surgery
- Pink, frothy sputum.
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Diagnostics related to PE
- VQ (ventilation/perfusion) scan
- D-dimer
- Lung CT scan, spiral CT
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