Overview
This lecture covered chest trauma, key injury types, chest tube management, and the use and troubleshooting of chest drainage systems, with an emphasis on clinical assessment, expected findings, and nursing interventions.
Chest Trauma Overview
- Major chest injuries include pulmonary contusion, rib fractures, flail chest, pneumothorax, and hemothorax.
- General management includes airway, breathing, and circulation (ABCs), oxygen, possible intubation, mechanical ventilation, chest tubes, or surgery.
- Assess for increased respiratory rate, accessory muscle use, decreased oxygen saturation, and respiratory distress.
- Check for asymmetrical chest rise and absent breath sounds to identify possible pneumothorax.
- Keep patients on bed rest to reduce oxygen demand and monitor closely for complications.
Specific Chest Injuries
- Pulmonary Contusion: Bruising of lung tissue, often asymptomatic at first; watch for hemoptysis, crackles, wheezes, and dull percussion; risk for ARDS.
- Rib Fractures: Pain at site, splinting/guarding, shallow breathing; monitor for complications like pneumothorax or pulmonary contusion.
- Flail Chest: Two or more consecutive rib fractures; hallmark is paradoxical chest movement; risk of poor gas exchange; may require mechanical ventilation or surgery.
- Pneumothorax/Hemothorax: Air or blood in pleural space causes lung collapse; hallmark signs are asymmetrical chest expansion and absent breath sounds; requires restoring negative pleural pressure, typically with a chest tube.
Chest Tubes and Drainage Systems
- Chest tubes restore negative pleural pressure to re-expand the lung.
- Tube is sutured in place; connected to a chest drainage system, usually with wall suction.
- Tube placement: higher for air (pneumothorax), lower for fluid (hemothorax).
- Apply petroleum gauze around insertion site to create a seal; keep drainage system below chest level.
Chest Drainage Systems: Types & Management
- Key Chambers: All systems have a drainage collection chamber and a water seal chamber.
- Water Seal Chamber: Acts as a one-way valve; water level must be at least 2 cm; intermittent bubbling is normal, continuous bubbling indicates an air leak.
- Dry Suction System: Uses a dial to regulate suction; orange indicator (flange) shows proper suction.
- Wet Suction System: Uses water for suction control; continuous gentle bubbling in the suction chamber indicates working suction.
- Track output every 8 hours; over 100 mL/hr requires provider notification.
- Do not remove suction without a provider order.
Complications & Interventions
- Dislodged chest tube: Cover site with sterile gauze taped on three sides, leaving one side open.
- Disconnected tube: Submerge end in sterile saline until reconnected.
- Avoid clamping, stripping tubing, or raising drainage system above chest.
- Subcutaneous emphysema (air under skin): Monitor airway closely.
- Pain management: Toradol (ketorolac) is often used; monitor renal function and limit dosing.
Key Terms & Definitions
- Pulmonary Contusion — Bruising of lung tissue caused by blunt trauma.
- Flail Chest — Segment of ribs broken in multiple places causing paradoxical movement.
- Pneumothorax — Air in pleural space leading to lung collapse.
- Hemothorax — Blood in pleural space leading to lung collapse.
- Water Seal Chamber — Chamber in drainage system acting as one-way valve.
- Wet/Dry Suction — Types of chest drainage systems; wet uses water for suction, dry uses mechanical dial.
- Titling — Up and down movement of water in seal chamber with respiration; normal finding.
Action Items / Next Steps
- Review and memorize hallmark signs and chamber functions for each chest injury and drainage system.
- Practice charting output and identifying appropriate responses to system complications.
- Complete ABG assignment in next session; retrieve answer keys posted by instructor.