Page 245 - Critical Care Notes

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■ Chest or thoracic injuries: Resulting from either blunt trauma or a penetrat-
ing injury.
■ Common injuries include rib fractures, flail chest, ruptured diaphragm,
aortic disruption, pulmonary contusion, tension or open pneumothorax,
hemothorax, penetrating or blunt cardiac injuries, and cardiac tamponade.
■ Abdominal injuries: Caused by blunt trauma or penetrating injury.
■ Common injuries include liver and spleen damage, renal trauma, bladder
trauma, and pelvic fractures.
■ Musculoskeletal injuries: Include spinal cord injury, fracture, dislocation,
amputation, and tissue trauma.
■ Fat embolism may occur secondary to fractures of the long bones.
Diagnostic Tests

■ CBC
■ Serum chemistry panel, including electrolytes, glucose, BUN, and creatinine
■ Liver function tests
■ Serum amylase if pancreatic injury suspected or GI perforation is present
■ Serum lactate level
■ PT and PTT
■ Urinalysis
■ ABGs or pulse oximetry
■ ECG
■ Type and crossmatch for possible blood transfusion
■ Drug and alcohol toxicology screens
■ Pregnancy test for female patients of childbearing age
■ X-rays specific to injury (e.g., chest, abdomen and pelvis, extremity)
■ CT scan of the abdomen (ultrasound if indicated)
■ Diagnostic peritoneal lavage if internal abdominal bleeding suspected
■ Rectal or vaginal examination if indicated
Management
Management is highly dependent on the type of trauma.
■ Maintain patent airway. Assess respiratory status for signs of trauma,
tachypnea, accessory muscle use, tracheal shift, stridor, hyperresonance,
dullness to percussion, rate depth, and symmetry.
■ Monitor ABGs or pulse oximetry.
■ Observe for respiratory distress and rising peak inspiratory pressure.
■ Assess chest wall integrity for flail chest or pneumothorax.
■ Administer O 2 via nasal cannula, mask, or mechanical ventilation. Use
oropharyngeal or nasopharyngeal airway or endotracheal tube.
■ Insert chest tube if pneumothorax is present.
MULTISYS