Chest injuries.ppt

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Chest injuries :

Chest injuries Conducted by: Ms.Monika (Clinical instructor) Army college of nursing ,

Definition :

Definition A person with a chest injury has damage to a structure in the chest, caused by an injury. Minor injuries may cause a bruise to the chest while severe injuries may also damage the lungs or heart. Soft tissue chest injuries include stab wounds , lacerations , abrasions , .

Clinical manifestation :

Clinical manifestation Symptoms of a chest injury include chest pain Bruising chest wall tenderness swelling

Treatment:

Treatment Treatment of a chest injury depends on the severity of the injury. General measures include rest, cold compresses nonsteroidal anti-inflammatory medications for pain. Narcotic pain medications may be prescribed for rib fracture . Deep breathing exercises may be recommended to lessen the risk for atelectasis and pneumonia .

Specific chest injury :

Specific chest injury Fractured rib Fractured sternum Flail chest

a) Fractured rib :

a) Fractured rib A rib fracture is a break or fracture in one or more of the bones making up the rib cage. The first rib is rarely fractured because of its protected position behind the clavicle.

Etiology :

Etiology It is associated with: Fall A blow to the chest Coughing or sneezing in osteoporosis Impact of the chest against a steering wheel

Clinical manifestation :

Clinical manifestation Localized pain Tenderness over the fracture area on inspiration & palpation. Bruising over the site of injury Minimized chest movements. Fractured rib compromise ventilation by three mechanism: a) Pain from the injury causes shallow breathing.

Cont……………d:

Cont……………d b) Secretions accumulation and obstruct the bronchi c) It leads to the development of site of infection & reduces the lung compliance.

Diagnostic evaluation :

Diagnostic evaluation A chest x-ray is usually taken to make certain there is no collapse or bruising of the lung. Ultrasound or CT scan may help diagnosis intra-abdominal injuries.

Management of fractured rib :

Management of fractured rib Fractured rib is generally treated with: Pulmonary physiotherapy Pain management Adequate pain control & spilinting of the chest during coughing & deep breathing help the client with rib facture to carry out painful but vital mobilization.

Cont………….d:

Cont………….d If pain is severe enough ,a local anesthetic solution may be injected at the fractured site itself. A chest film should be taken to check the pneumothorax & hemothorax. The pain from fractured ribs usually lasts 5 to 7 days. Compete healing in approximately 6 to 8 weeks.

Cont…………..d:

Cont…………..d Bronchodilators and nebulised saline may be prescribed and given regularly to aid the expectoration of secretions and should be linked with physiotherapy. Oxygen should be humidified to prevent the drying of airways and secretions If a patient is unconscious or struggling to clear secretions independently, suction via a nasopharyngeal or oral airway can be carried out.

Complication of fractured rib:

Complication of fractured rib Hypoventilation - Hypocapnia - Hypoxia - Atelectasis - Pneumonia

b) Fractured sternum :

b) Fractured sternum A sternal fracture is a fracture of the sternum (the breastbone), located in the center of the chest

Cont…………..d:

Cont…………..d The injury, which occurs in 5–8% of people who experience chest trauma, may occur in vehicle accidents, when the chest strikes a steering wheel or dashboard or is injured by a seatbelt. Sternal fracture can interfere with breathing by making it more painful; however, its primary significance is that it can indicate the presence of serious associated internal injuries, especially to the heart and lungs.

Signs and symptoms:

Signs and symptoms Crepitus: (a crunching sound made when broken bone ends rub together) pain tenderness bruising and swelling over the fracture site. The fracture may visibly move when the person breathes Associated injuries such as those to the heart may cause symptoms such as abnormalities seen on electrocardiograms.

Diagnostic evaluation :

Diagnostic evaluation X-rays of the chest are taken in people with chest trauma and symptoms of sternal fractures, CT scanning Since X-rays taken from the front may miss the injury, they are taken from the side as well

Management of client with fractured sternum:

Management of client with fractured sternum Use of NSAID:( to manage the pain) : Once a sternal fracture has been identified, you will be directed to take ibuprofen as an anti-inflammatory and a pain medication. injured sternum should not be wrapped or placed in any type of cast. It is believed that the best healing occurs a client is able to breathe and move regularly rather than in a restricted manner.

Cont………..d:

Cont………..d If the fracture is large, surgery could be necessary to stabilize the sternum. Rest the injured area. You will want to get a few days of bed rest where you support the area as well as you can so that movement does not creates pain. For the first two weeks, limit movement as much as possible but start some walking around so that the area heals appropriately. Take the pain medication and ibuprofen regularly.

cont……….d:

cont……….d After a few weeks, the client resume back into normal activity. the client will be able . tolerate it. The pain medication is useful so that you can tolerate getting back into activity. Just be careful not to irritate the sternal fracture which will cause it to take longer to heal. doctor may recommend physical therapy. This may help you build back up the strength in your chest muscles, as well as allow for getting back range of movement

3) Flail chest :

3) Flail chest A flail chest occurs when a segment of the thoracic wall becomes unattached from the rest of the chest wall. This most typically occurs when ribs are fractured in two places, allowing that segment of the thoracic wall to "float" independently of the rest of the chest wall.

Cont..d:

Cont..d Flail chest refers to a section of the rib cage that has broken away from the surrounding ribs. and they are broken in at least two places. In other words, as the rest of the chest expands to suck in a breath of air, the flail chest segment sucks in. During exhalation, when the rest of the chest contracts, the flail chest segment bulges out. Often, a grinding sound or feeling called crepitus

Sign & symptom:

Sign & symptom Breathing problems Multiple rib fractures Unstable chest wall Pain Abnormal chest movement during respiration

Treatment of flail chest:

Treatment of flail chest It is dictated by the clinical condition and degree of respiratory distress. Local anesthetic block of the affected ribs & it will decrease the patient's pain. If the flail segment is impairing gas exchange or contributing to hypoxemia, the flail segment should be supported by a firm chest wrap or temporarily by laying the patient with the flail segment down against the exam table. This prevents the flail segment from moving out during expiration. Oxygen supplementation may be necessary depending on the underlying lung pathology. Surgical stabilization of the flail segment is rarely necessary

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