Chest Trauma Concept Map

(1)

Predisposing/Precipitating Factors Pathophysiology Signs/Symptoms Diagnostic Exams Medical Treatment Complication Nursing Diagnosis Nursing Management Pathophysiology Others FAST Ultrasound Upright chest radiograph

FAST Ultrasound Upright chest radiograph

Chest Drain (closed system) Thoracotomy Chest Drain (closed system) Thoracotomy Empyema Empyema

Surgery (Thoracostomy or Mini-Thoracotomy)

Surgery (Thoracostomy or Mini-Thoracotomy) Fibrothorax Fibrothorax Thoracotomy Decortication Thoracotomy Decortication

Blood that enters chest cavity is exposed to motion of diaphragm,

lungs and other intrathoracic structures

(2)

Defibrination of the blood results so that incomplete

clotting occurs

Fluid leaks into the pleural space

Increased permeability Increased permeability Lysis of RBCs results in protein concentration of the

pleural fluid

Lysis of RBCs results in protein concentration of the

pleural fluid

Within several hours, lysis of existing clots by pleural

enzymes begins

Pleural Effusion Pleural Effusion

(3)

Occurence of the incident (kicking) Occurence of the incident (kicking) Predisposing Factors Age Gender Predisposing Factors Age Gender

Blunt trauma on left side of lung

Force causes disruption of the tissues of the chest wall

and pleura

Blood accumulates in the chest cavity

Bleeding occurs Bleeding occurs FAST Ultrasound

Upright chest radiograph FAST Ultrasound Upright chest radiograph

Decreased chest and lung expansion Dullness on affected part upon percussion Reduced breath sounds

in affected part Decreased chest and

lung expansion Dullness on affected part upon percussion Reduced breath sounds

in affected part Chest Drain (closed system) Thoracotomy Chest Drain (closed system) Thoracotomy Ineffective breathing pattern r/t decreased lung expansion secondary to fluid accumulation Ineffective breathing pattern r/t decreased lung expansion secondary to fluid

accumulation _{Pressure becomes more}

positive

Pressure becomes more positive

Disruption of normal respiratory movement Disruption of normal respiratory movement Blood that enters chest cavity is

exposed to motion of diaphragm, lungs and other intrathoracic

structures

Jugular Vein Distension Jugular Vein

(4)

Abnormalities of ventilation and oxygenation may occur

Abnormalities of ventilation and oxygenation may occur Defibrination of the blood

results so that incomplete clotting occurs

clotting occurs

Fluid leaks into the pleural space

Increased permeability Increased permeability Lysis of RBCs results in protein concentration of the

pleural fluid

Lysis of RBCs results in protein concentration of the

pleural fluid

enzymes begins

Tachypnea

RR- 40 CPM, Shallow Dyspnea and pain upon breathing

Tachypnea

Pleural Effusion Pleural Effusion

(5)

Occurence of the incident (kicking) Occurence of the incident (kicking) Precipitating Factors Chest Trauma Occupational Hazards Environmental Hazards alcohol consumption Precipitating Factors Chest Trauma Occupational Hazards Environmental Hazards alcohol consumption

Blunt trauma on left side of lung

and pleura

Blood accumulates in the chest cavity

Bleeding occurs Bleeding occurs

- External bruising on the affected part - Areas of tenderness over affected side - External bruising on the affected part - Areas of tenderness over affected side

Mediastinal shift (R) Mediastinal shift (R)

Impaired gas exchange r/t altered oxygen supply Impaired gas exchange r/t altered oxygen supply

Pressure becomes more positive

Pressure becomes more positive Disruption of normal respiratory movement Disruption of normal respiratory movement Excessive bleeding (hemothorax) Excessive bleeding (hemothorax) Palpable fremitus Palpable fremitus

(6)

Abnormalities of ventilation and oxygenation may occur

Tachypnea

(7)

Precipitating Factors Chest Trauma Occupational Hazards Environmental Hazards alcohol consumption Precipitating Factors Chest Trauma Occupational Hazards Environmental Hazards alcohol consumption Chest X-rayImpression: Hemothorax CT scan:

Hemothorax and Tension ABG:

Chest X-rayImpression: Hemothorax

CT scan:

- External bruising on the affected part - Areas of tenderness over affected side - External bruising on the affected part - Areas of tenderness over affected side

Ineffective tissue perfusion r/t excessive blood loss Ineffective tissue perfusion

r/t excessive blood loss Impaired gas exchange r/t

altered oxygen supply Impaired gas exchange r/t altered oxygen supply

Excessive bleeding (hemothorax)

Excessive bleeding

(hemothorax) Hypovolemic Hypovolemic _shock_shock DEATHDEATH

Early signs: Abrupt decrease in blood pressure Tachycardia 105 BPM Tachypnea 40 CPM Decreased pulse ampitude and rhythm (Weak and Threading)

Early signs: Abrupt decrease in blood pressure Tachycardia 105 BPM Tachypnea 40 CPM Decreased pulse ampitude and rhythm (Weak and Threading) Blood Loss of 4000 mL (12

hours) and 1000 mL (retained clots)

Blood Loss of 4000 mL (12 hours) and 1000 mL (retained

(8)

(9)

CT scan:

Hemothorax and Tension ABG: DEATH DEATH Early signs: Abrupt decrease in blood pressure Tachycardia 105 BPM Tachypnea 40 CPM Decreased pulse ampitude and rhythm (Weak and Threading)

(10)