Oxygen Deprivation

Oxygen Deprivation LUNG COMPRESSION

Objectives Describe complications of lung compression and

chest trauma across life span Describe clinical manifestations Apply nursing management principles and measures

Chest trauma Can occur alone or in combination Blunt Penetrating

Blunt Trauma Sudden lung compression or positive

pressure inflicted to chest wall. Symptoms may be generalized or vague so difficult to identify Patient may or may not seek immediate medical attention. Diminished breath sounds

Common Causes MVA Falls Hitting the chest Patient being thrown into an object Compression e.g. crush injury

Results Hypovolemia from massive fluid loss Hypoxemia from disruption of airway Cardiac failure Injuries are often life threatening Impaired ventilation and perfusion leading to

acute respiratory failure Time crucial when treating because of location and possible injury to great blood vessels

Determine Time since injury occurred Level of responsiveness Specific injuries Recent drug or alcohol use Mechanism of injury Estimated blood loss Airway obstruction Breath sounds symmetry

Diagnostics Chest x-ray CT scan CBC INR, PT, PTT Type and cross match Pulse Ox Arterial blood gases ECG

Goals Evaluate patients condition Initiate aggressive resuscitation O2 support Possible intubation and ventilator support Reestablish fluid volume Reestablish negative pleural pressure

Pneumothorax Parietal or visceral pleura in breached and pleural

space is exposed to positive atmospheric pressure Simple Traumatic Tension

Simple Air enters pleural space, lungs collapse Rupture of a bleb (fluid filled sac) There is usually only partial collapse of a lung Trachea is midline S/S include

Chest pain that can be dull, sharp, or stabbing. Pain starts suddenly and becomes worse with coughing or deep breathing. Shortness of breath Tachypnea Cough. 

Traumatic Air escapes from lung laceration Can occur during invasive procedures e.g. biopsy Often accompanied by hemothorax Lung and structures of mediastinum (heart and

great vessels shift towards the uninjured side with each inspiration and the opposite way with expiration Requires emergency intervention

Traumatic Signs and Symptoms SOB Anxious patient Tachypnea Sucking sound heard because of the rush of

air through the wound in the chest wall e.g. sucking chest wounds

Tension Air is drawn into the pleural space from a lacerated lung or

through a small opening or wound in the chest but does not leave, it gets trapped in the pleural space Any condition that leads to pneumothorax can cause a tension pneumothorax As the amount of trapped air increases, pressure builds up in the chest pushing the heart, major blood vessels, and airways toward the other side of the chest. Trachea shifts away from the affected side. The shift can cause the other lung to become compressed, and can affect the flow of blood returning to the heart.

Tension Signs and Symptoms  Symptoms occur very suddenly and are very severe.  The patient becomes extremely anxious  SOB  Chest tightness  Easy fatigue  Bluish color of the skin due to lack of oxygen  Tachycardia  Low blood pressure  Decreased mental alertness  Decreased LOC  Tachypnea  Bulging (distended) veins in the neck

Hemothorax  Common cause chest trauma  Collection of blood in the space between the chest wall and

the lung (the pleural cavity).  S/S  Chest pain  SOB  Respiratory failure  Tachycardia  Anxiety and restlessness

Goals of Treatment Stabilize the patient Stop the bleeding Remove the blood and air in the

pleural space

Pleural Effusion Collection of fluid in the pleural space Rarely a primary disease May be complication of heart failure,

pneumonia, TB, neoplasm, PE

Pathophysiology Normally the pleural space contains a small

amount of fluid which acts as lubricant However with pleural effusion fluid is excessive. Fluid types are:  Clear  Bloody  Purulent

Clear Can be transudate or an exudate Transudate are caused by systemic factors that

alter the balance of the formation and absorption of pleural fluid e.g. left ventricular failure, PE, cirrhosis Exudate are caused by alterations in local factors that influence the formation and absorption of pleural fluid e.g. bacterial pneumonia, cancer, and viral infection

Signs and Symptoms Many people have no symptoms The most common symptoms, regardless of the type

of fluid in the pleural space or its cause, are:  SOB  Chest pain (pleuritic) felt only when the person breathes deeply or coughs, or it may be felt continuously but may be worsened by deep breathing and coughing.  The pain is usually felt in the chest wall right over the site of the inflammation.

Management Small pleural effusions may not require treatment,

although the underlying disorder must be treated. Larger pleural effusions, especially those that cause shortness of breath, may require drainage of the fluid (thoracentesis). Usually, drainage dramatically relieves shortness of breath. If effusion is related to malignancy it tends to recur within a few days or weeks.

Talc Used to prevent malignant pleural effusion

(buildup of fluid in the chest cavity in people who have cancer or other serious illnesses) in people who have already had this condition. Talc is in a class of medications called sclerosing agents. It works by irritating the lining of the chest cavity so that the cavity closes and there is no space for fluid.

Nursing Care Prepare and position patient for thoracentesis Offer support through procedure Need to make sure amount of fluid drained is

recorded and sent to lab for testing Chest tube may also be inserted for larger amounts of fluid to be removed. Evaluate pain level Administer analgesics Education re: care of chest tube

Empyema Complication of bacterial pneumonia or lung abscess Collection of pus in the cavity between the lung and the

membrane that surrounds it (pleural space). Puts pressure on lungs Risk factors include: Pneumonia Lung abscess Trauma Thoracic surgery

Signs and Symptoms Similar to an acute respiratory infection Dry cough Febrile and chills Excess sweating, especially night sweats Malaise Weight loss Chest pain which worsens on deep inhalation

(inspiration) Decreased or absent breath sounds

Diagnostics Chest x-ray Thoracentesis Pleural fluid gram stain and culture CT scan of chest Drain pleural cavity to achieve full lung expansion   

Thoracentesis Chest drainage tube Thoracotomy

Administer antibiotics

Nursing Management Help patient cope with long process Educate regarding lung expansion

exercises Depending on type of drainage, nurse supports patients

Flail Chest Life threatening emergency Occurs when a segment of the chest wall breaks

under extreme stress and becomes detached from the rest of the chest wall. It occurs when multiple adjacent ribs are broken in multiple places, separating a segment, so a part of the chest wall moves independently.

Presentation Inspiration: as chest expands, the detached part of the rib

segment (flail segment) moves in a paradoxical manner. It is pulled inward during inspiration, reducing the amount of air that can be drawn into lungs. Expiration: flail segment bulges outward impairing the patients ability to exhale. Mediastinum shifts back to affected side. The constant motion of the ribs in the flail segment at the site of the fracture is incredibly painful, and, untreated, the sharp broken edges of the ribs are likely to eventually puncture the pleural sac and lung, possibly causing a pneumothorax

Management Vent support Clear secretions from lungs Control pain Severe flail requires endotrachial intubation and

mechanical ventilation Careful monitoring of chest x-ray, arterial blood gases, pulse ox