Respiratory Trauma for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Respiratory Trauma for Certified Emergency Nursing (CEN)
Outline
Respiratory Trauma
Definition/Etiology:
Blunt, penetrating and blast trauma can all cause swelling of lung tissue and compromised gas exchange (pulmonary contusion, edema, and ARDS).
Mechanical problems compromising lung filling:
- Fracture of chest wall bones (flail segment)
- Hemothorax
- Pneumothorax
- Tension pneumothorax
Pathophysiology:
Compression of lung / alveoli from tension pneumothorax / atelectasis / hemothorax.
Compromised gas exchange from pulmonary edema / ARDS / pulmonary contusion.
Blast injury–
- Primary: blast wave of air damages alveoli
- Secondary: shrapnel hits chest
- Tertiary: chest wall can hit stationary objects
Clinical Presentation:
- Dyspnea
- Low oxygen saturation (can develop late)
- Crepitus
- Decreased lung sounds
- Abnormal movement of chest wall
- Deviated trachea
Collaborative Management:
- Supplemental oxygen for all
- Needle decompression if tension
- Flutter valve dressing if penetrating trauma
- Chest thoracostomy tube if hemo and/or pneumo
- CXR/CT
- Collaborate with respiratory therapy
- Arterial blood gasses
Evaluation | Patient Monitoring | Education:
- Continuous oxygen saturation
- Monitor output of chest tube
- Continuous cardiac monitoring
- Be alert for late changes of pulmonary edema and ARDS
Linchpins: (Key Points)
- Gas exchange is the goal
- Understand P:F ratio
- Watch for development of tension
- Late edema / ARDS can occur
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Legome, E. (2022, September 28). Initial evaluation and management of blunt thoracic trauma in adults. UpToDate. https://www.uptodate.com/contents/initial-evaluation-and-management-of-blunt-thoracic-trauma-in-adults
- Winkle, J. M. (2022, September 29). Initial evaluation and management of penetrating thoracic trauma in adults. UpToDate. https://www.uptodate.com/contents/initial-evaluation-and-management-of-penetrating-thoracic-trauma-in-adults
- American Academy of Pediatrics. (2021, November 1). Blast terrorism and explosions: disaster management resources. https://www.aap.org/en/patient-care/disasters-and-children/disaster-management-resources-by-topic/blast-terrorism-and-explosions/