Page 300 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 285

Treatment

Pain control using intercostal nerve blocks, patient-controlled analgesia
(PCA), epidural analgesia

Avoiding narcotics, which can lead to respiratory depression and hypoventilation
Intubation and mechanical ventilation (MV) using positive pressure to help
stabilize a flail internally (see Chapter 2, Care of the Patient With Critical
Respiratory Needs)

Nursing Interventions
Assess the patient for bruising around the chest and neck in the area of seat
belts, which can indicate traumatic injury associated with bony thorax.
Palpate for subcutaneous emphysema (crepitus) in the chest area, which is
caused when air leaks from the lungs through the skin from trauma.
Continuously monitor for other injuries like punctured blood vessels or lung
contusion, as a flail may not show up right away until the patient is working
harder to breathe.

Monitor for pneumonia by assessing temperature, lung sounds for crackles,
and sputum cultures/sensitivities. Pneumonia is the most common complication 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.
of a chest injury.
Administer analgesics via protocol, which may include PCA and epidurals to
help control pain leading to hypoventilation.

NURSING ALERT

A flail chest may not be diagnosed immediately! Check the mechanism of injury, the

number and place of ribs fractures, and look for signs/symptoms of underlying lung
contusion, which would lead to a high index of suspicion for a flail.

Acute Lung Injuries (ALIs)

What Went wrong?
Pulmonary contusion, hemothorax, pneumothorax, and tension pneumothorax
are injuries to the lungs that can occur from multiple trauma. A pulmonary
contusion is bruising of the lung tissue as a result of trauma. Damage to the
capillaries in the lung tissue causes blood and other fluids to accumulate in the
traumatized area, leading to hemorrhage, inflammation, and interstitial edema.
The end result is hypoxemia. A pulmonary contusion is the most common
potentially lethal chest injury.