trauma presentation

TRAUMA AND
EMERCENCY
NURSING
BY SEELAA SEGARAN

The nursing care and management of a client with
Tension
Pneumothorax.

INTRODUCTION

ANATOMY OF
THE LUNG

DEFINATION
OF TENSION
PNEUMOTHORAX

PROGRESSIVE BUILD­UP OF AIR
WITHIN THE PLEURAL SPACE
DUE TO A LUNG LACERATION AIR TO ESCAPE INTO THE PLEURAL
SPACE BUT NOT TO RETURN

'ONE­WAY­VALVE' EFFECT PUSHES THE MEDIASTINUM
OBSTRUCTS VENOUS RETURN =
CIRCULATORY INSTABILITY
TRAUMATIC ARREST.

SYMPTOMS

 Respiratory distress
 Distended neck vein
 Tracheal deviation
 Tachycardia
 Low blood pressure
 Cyanosis
 Decreased lung sounds

MANAGEMENT OF A
TENSION
PNEUMOTHORAX

• Open chest wound – seal the wound with an occlusive dressing.
• Needle thoracostomy or needle compression. • Chest tube.

CASE STUDY: MR. S

DEMOGRAPHIC
DATA

Patient’s Name

: Mr. S

Age

: 35 Yrs Old

Sex
Marital Status
Religion

: Male
: Married
: Hinduism

Race

: Indian

Nationality

: Malaysian

Address

: Taman Bayu Perdana

Occupation

: Unknown

Next Of Kin

: Wife.

Allergic

: NIL

Past Medical History : NIL Past Surgical History: NIL Social History

:Non Alcoholic
Non Smoker

HISTORY FROM TRIAGE
Brought in to ED via ambulance
On cervical collar and immobilizer at right leg
Multiple abrasion wound
 right leg pain, swelling, tenderness and bruising Hematoma at right temporal

H/O MVA @ 1000hrs (motorbike versus lorry)
Head on collision
Pt was a rider
Wearing helmet
LOC at scene now drowsy
ENT bleed (severe nose bleed)

Immediate action
Cervical collar
Compress
HGT
Iv access
ATT

PRIMARY
ASSESMENT

Airway - unable to maintain airway patency intubated ETT size 7.5 (for airway protection) Breathing - Tachypnea and stridor
Circulation – pulse rate : 100bpmin unresponsive capillary refill less than 3 sec no obvious bleeding noted

Disability – GCS 8 : No eyes opening (1)
:making incomprehensible sound (2)
:localizes to a painful stimulus (5)
- Pupil :3mm and equal
: