Page 296 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 281

NURSING ALERT

Nasal intubation (pulmonary and gastric) is contraindicated in the presence of facial
fractures because of the danger of passing the tube into the cranium.

For more information on facial injuries, go to http://emedicine.medscape.
com/article/434875-overview (last accessed July 10, 2010).

Tracheobronchial Injuries (TBI)

What Went Wrong?
The tracheal and bronchial areas are unprotected and can be injured in an
MVC when these areas hit the dashboard or steering wheel. They are also asso-
ciated with injuries like esophageal, spinal, and vascular damage.
The neck area where the tracheobronchial tree is located is highly susceptible
to spinal cord injury from acceleration-deceleration injuries. The airway must
first be monitored, as blunt or penetrating injury can cause airway narrowing and
possible closure due to swelling from trauma to the area. Lacerations to the
trachea can lead to massive air leaks into the subcutaneous tissues also causing Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
swelling, with crackling felt under the skin upon palpation. The patient will need
to be monitored for airflow, severe swelling, and subcutaneous emphysema.
As with the MFIs, tracheobronchial injuries can involve vascular damage
leading to blood loss from the rupture of major vessels in this area. The patient
will need to be monitored for blood loss leading to hypovolemic shock.

Prognosis
Severe injury to the tracheobronchial area results in an increased mortality rate.

Interpreting Test Results
Cervical spine x-rays must rule out fractures to the spinal cord.
Head and neck x-rays will show the extent of injury and bleeding.

MRI of neck will help show extent of injury and bleeding.
Chest x-ray will confirm diagnosis of subcutaneous emphysema.
ABG will assist with gas exchange difficulties.

Hallmark Signs and Symptoms

Often can be subtle and overlooked
Cough