Respiratory Trauma

Respiratory Trauma

Definition/Etiology:

Blunt, penetrating and blast trauma can all cause swelling of lung tissue and compromised gas exchange (pulmonary contusion, edema, and ARDS).

Mechanical problems compromising lung filling:

• Fracture of chest wall bones (flail segment)
• Hemothorax
• Pneumothorax
• Tension pneumothorax

Pathophysiology:

Compression of lung / alveoli from tension pneumothorax / atelectasis / hemothorax.

Compromised gas exchange from pulmonary edema / ARDS / pulmonary contusion.

Blast injury–

• Primary: blast wave of air damages alveoli
• Secondary: shrapnel hits chest
• Tertiary: chest wall can hit stationary objects

Clinical Presentation:

• Dyspnea
• Low oxygen saturation (can develop late)
• Crepitus
• Decreased lung sounds
• Abnormal movement of chest wall
• Deviated trachea

Collaborative Management:

• Supplemental oxygen for all
• Needle decompression if tension
• Flutter valve dressing if penetrating trauma
• Chest thoracostomy tube if hemo and/or pneumo
• CXR/CT
• Collaborate with respiratory therapy
• Arterial blood gasses

Evaluation | Patient Monitoring | Education:

• Continuous oxygen saturation
• Monitor output of chest tube
• Continuous cardiac monitoring
• Be alert for late changes of pulmonary edema and ARDS

Linchpins: (Key Points)

• Gas exchange is the goal
• Understand P:F ratio
• Watch for development of tension
• Late edema / ARDS can occur