Page 302 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 287

NURSING ALERT

There is no single test or diagnostic procedure to confirm a pulmonary contusion,

and often the clinical picture along with a high index of suspicion and close monitor-
ing for signs/symptoms will help in diagnosis.

Hallmark Signs and Symptoms

TABLE 6–6 Lung Injuries and Their Signs/Symptoms
Lung Injury Signs/Symptoms
Pulmonary May take up to 24–48 hours to develop
contusion Low SaO
2
Circumoral and mucous membrane cyanosis
Moist crackles in affected areas
Hemothorax Dullness to percussion
Decreased chest wall expansion in the affected lung
Diminished breath sounds on the affected side
Signs/symptoms of shock if a large hemothorax
Pneumothorax Resonance on chest percussion 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.
Palpation of crepitus and rib fractures
Tracheal shift from midline
Diminished or absent breath sounds on the affected side
Tension Dyspnea with acute respiratory distress
pneumothorax Tachycardia
Hypotension
Tracheal deviation away from the affected side
Diminished or absent breath sounds opposite the injured
side
Sudden chest pain that radiates to shoulders
Traumatic cardiac arrest with pulseless electrical activity (PEA)

Treatment
Oxygen must be administered.
Chest tube compression in event of pneumothorax and hemothorax.
Emergency needle thoracostomy when time is of extreme essence.

Heimlich valve insertion if chest tube compression is unavailable.
Possible surgery if chest tube output does not decrease in a hemothorax.