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Blunt mechanism chest wall injury (CWI) is commonly seen in the emergency department (ED), since it is present in around 15% of trauma patients. The thoracic cage protects the heart, lungs and trachea, thereby supporting respiration and circulation, so injury to the thorax can induce potentially life-threatening complications. Systematic care pathways have been shown to improve outcomes for patients presenting with blunt mechanism CWI, but care is not consistent across the UK. Emergency nurses have a crucial role in assessing and treating patients who present to the ED with blunt mechanism CWI. This article discusses the initial assessment and acute care priorities for this patient group. It also presents a prognostic model for predicting the probability of in-hospital complications following blunt mechanism CWI., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Background: Blunt chest injuries not treated in a timely manner with sufficient analgesia, physiotherapy and respiratory support are associated with increased morbidity and mortality. The aim of the study was to determine the impact of a blunt chest injury early activation protocol (ChIP) on patient and hospital outcomes., Methods: In this pre-post cohort study, the outcomes of patients with blunt chest injury who received ChIP were compared against those who did not. Data including injury severity, patient outcomes, hospital treatments and comorbidites were extracted from medical records. The primary outcome was pneumonia. Secondary outcomes evaluated health service delivery. Logistic and multiple regressions were used to adjust for potential confounding variables., Results: 546 patients were included, 273 in the before-ChIP cohort and 273 in the after-ChIP cohort. The incidence of pneumonia following the introduction of ChIP was reduced by 4.8% (95% CI 0.5-9.2, p=0.03). In the after-ChIP cohort, more patients received a pain team review (32% vs. 13%, p<0.001), physiotherapy (93% vs. 86%, p=0.005) and trauma team review (95% vs. 39%, p<0.001). There was no difference in length of stay (p=0.50)., Conclusions: ChIP improved the delivery of healthcare services and reduced the rate of pneumonia among patients with isolated chest trauma., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

Multi-trauma patients need specific care provided by medical teams and hospitals with a technical platform that optimises emergency care.They also require a special 'shock management' unit with staff members available to welcome these patients and maintain their vital functions.

Management of blunt injury to the boney thorax centers on the hospital; yet, these injuries continue to impact patients long after hospitalization. The purpose of this literature review was to identify long-term outcomes associated with this injury. A literature search found 616 studies and, after screening, yielded 6 articles for review. Patient and injury characteristics and postinjury assessment findings were explored. The impact of this injury can be prolonged and life altering, prompting the need for further investigation. A greater understanding of injury-specific posthospitalization outcomes could elucidate the impact of these injuries on patients, families, and society.

Dyspnea is one of the most common presenting symptoms in thoracic trauma patients; therefore, trauma nurses require extensive knowledge of this symptom. The Human Response to Illness model provides an organizing framework to establish a comprehensive understanding of the human response of dyspnea following thoracic trauma. The model is used to describe the physiological, pathophysiological, behavioral, and experiential perspectives of dyspnea in thoracic trauma, while considering personal and environmental factors. This comprehensive overview will provide the trauma nurse with appropriate evidence-based rationale for interventions in the management of acute dyspnea in the thoracic trauma population.

Critically-ill patients who have sustained multiple traumatic injuries have complex, and often conflicting, physiological needs. These have profound implications on the way in which nursing staff approach the physical positioning of these patients to minimize the risks of further physiological injury and damage, maintain homeostasis and promote optimum recovery. This article reviews and discusses the evidence base underpinning therapeutic positioning of the multiply-injured trauma patient within the intensive-care unit (ICU), focusing on patients with a known or suspected unstable spinal injury, pelvic injury, traumatic brain injury, chest injury, or multiple limb fractures. Included are guidelines on the therapeutic positioning of the multiply-injured trauma patient within the ICU, based on the current available evidence and also drawn from practical experience within the author's own place of work. There is also a brief discussion of how such guidelines may be introduced into clinical practice.

Cardiac trauma fatalities occur in 22% of victims of motor vehicle crash. Blunt cardiac trauma may result in myocardial rupture. Mechanisms of injury include compression, deceleration, laceration, and "hydraulic ram" effect. Diagnosis is difficult because of coexisting injuries and the lack of evidence-based protocols. Physiological changes in the elderly and the presence of comorbid illness result in poor survival rates when myocardial rupture occurs. Trauma nurses must be prepared to provide end-of-life care related to the poor outcome associated with myocardial rupture. This case study reports a right ventricular rupture in an elderly patient involved in a frontal motor vehicle crash.

Deadly Dozen ... Lethal Six ... Hidden Six ... Major thoracic injuries are known as the Deadly Dozen. The Lethal Six (airway obstruction, tension pneumothorax, cardiac tamponade, open pneumothorax, massive hemothorax, and flail chest) are immediate, life-threatening injuries that require evaluation and treatment during primary survey. The Hidden Six (thoracic aortic disruption, tracheobronchial disruption, myocardial contusion, traumatic diaphragmatic tear, esophageal disruption, and pulmonary contusion) are potentially life-threatening injuries that should be detected during secondary survey. Each of these may present as immediately life-threatening or potentially life-threatening events. This article provides an overview of these 12 injuries and appropriate management for each. Case studies are included.

The incidence of myocardial contusion as a result of blunt chest trauma remains difficult to assess. As such the potentially lethal consequences are often difficult to mitigate against. The true incidence of myocardial contusion is not known and various authors have ascribed percentages in the very broad range of 8-71% of those having suffered blunt chest trauma. The extremely wide variation in presenting signs and symptoms further complicates the clinical picture creating a complicated and complex challenge for the assessing team. In the absence of clear guidelines to date a number of potential options are discussed exploring their efficacy and appropriateness in the management of those patients suffering from blunt chest trauma.

The formidable challenge of chest wall repair calls upon a multidisciplinary health care approach. The vital organs housed within the chest must be protected and the vascularity of available tissues used for repair must be maintained. Once chest wall reconstruction is complete, the patient must be closely monitored for stability and tissues must be protected from internal and external assaults. The following discussion will review the options for repair and the care of the patient undergoing chest wall defect reconstruction.

Care of patients with blunt cardiac trauma is challenging for bedside nurses because of the potentially elusive and subtle nature of clinical findings associated with such trauma. An understanding of the forces exerted during the trauma episode will assist nurses in the assessment and search for hidden injuries. A high index of suspicion and continued cautious assessment and attention to subtle changes in the patient's physical condition are essential. Keen attention to changes in the patient's vital signs, cardiac output, ECG findings, pulses, and fluid volume status alert nurses to potential injuries associated with blunt cardiac trauma ranging from myocardial contusion to cardiac tamponade, aortic tears, and cardiac rupture. Survival of patients with blunt cardiac trauma depends on early intervention.

Blunt chest trauma represents a challenge to both nurses and physicians due to the frequent absence of clinical signs. When evaluating or predicting blunt chest trauma several components are important to remember.

The lungs are remarkably resilient organs and injuries to the lungs, whether from blunt or penetrating trauma, are not often the source of mortality. Instead, associated injuries to the heart, great vessels, chest wall, and other critical structures account for most morbidity and mortality associated with thoracic trauma. Hypovolemic shock, impending cardiac failure, neurological injury, and compromised respiratory function may all be present in a single individual with thoracic trauma whose injuries require immediate surgery. Anesthesia care for the thoracic trauma patient often involves continued resuscitation to combat shock, as well as the careful administration of anesthetic agents. The choice of anesthetic agents must consider the patient's hemodynamic status, the potential for airway problems, associated injuries, and medical history.

Traumatic injuries are the primary cause of death in children. Nursing care that the critically injured child receives during the acute phases of resuscitation and stabilization and critical care have direct impact on potential for good long-term outcome. The nurse works in concert with other members of the trauma team to provide comprehensive assessment and interventions during both the primary and secondary surveys. Knowledge of mechanisms of injury in the pediatric population, patterns of injury unique to children, physiologic differences between adults and children and their impact on care, and developmental needs of children and families guide the trauma nurse in providing expert clinical care and caring psychosocial support to traumatized patients and families.

This article reviews the current concepts in penetrating chest trauma. The authors discuss mechanisms of injury, nursing assessment, and interventions for penetrating injuries resulting in cardiac rupture, cardiac tamponade, tension pneumothorax, hemothorax, great vessel injury, and sucking chest wounds.

This article outlines some of the concerns and considerations in the anesthetic management of critically ill patients with chest trauma during their initial resuscitation and intraoperative course. The management decisions made during this critical period have clear implications for patient care once the patient arrives in the intensive care unit. It is the goal of this article to outline the rationale for these management decisions in order to facilitate the transfer of the patient from the operating room or trauma bay to the intensive care unit and allow the critical care nurse to establish effectively the expectations for postoperative recovery.

While fewer patients with isolated blunt chest trauma are admitted to the ICU than in previous years, those with multisystem trauma or life-threatening injuries such as aortic disruption or massive lung contusion need aggressive nursing care. This article surveys the most widely encountered blunt thoracic traumas as well as difficult-to-diagnose myocardial and pulmonary injuries. Comprehensive trauma, thoracic assessment, and critical care therapeutics are discussed.

1. Epidemiology may affect admission. It is essential to know what types of trauma patients are typically admitted, at what time of day, and on which day of the week. Within trauma systems, one of the major determinants of patient survival is the adequacy of surgical personnel and equipment resources. 2. Assessment of the abdominal and thoracic trauma patient is an active process, requiring constant curious attention. Due to the time-critical nature of these injuries, effective communication is paramount. There may be little or no documentation, and minimal verbal report, consisting of mechanism of injury and vital signs. A stable patient may rapidly deteriorate. 3. Injury severity and location are key in patients' mortality and morbidity. Outcomes for vascular injury surgeries depend on time lag, differences in surgeons' experience, associated injury, site of wounds, type of arterial lesions, and infection.

Thoracic trauma is usually accompanied by other body system injury, most frequently head and skeletal injury. Developmental changes throughout childhood make the consequences of such injuries more severe, as children develop respiratory and circulatory compromise quickly. Blunt trauma predominates in pediatric thoracic trauma. Trauma to the thoracic cavity may involve fractures of the ribs or injuries where the ribs remain intact. Trauma involving the pleural space affects ventilation that may evolve into circulatory failure if not addressed promptly. Pulmonary contusion is among the most frequent and most fatal of thoracic injuries. Rupture of the tracheobronchial tree, esophagus, or diaphragm may have both short- and long-term consequences. Trauma to the heart and/or great vessels may be fatal at the scene of the accident, in the emergency department, or in the intensive care unit. Pain management is an essential part of caring for children with thoracic injury. A variety of methods have become available within the past several years that promote better pain relief and shorter recovery periods with less side effects. Nursing care of the child with PCA, epidural analgesia, or intercostal nerve blocks requires specific knowledge and assessment skills. Nonpharmacologic methods of pain relief may be used as an adjunct to pharmacologic methods.

Pediatric multitrauma causes more deaths and injuries each year in children than any other cause of death. Most of the multitrauma cases involve a motor vehicle accident. Blunt trauma and head injuries constitute the majority of injuries in pediatric multitrauma. Blunt trauma leaves minimal evidence of the underlying injury and is difficult to assess in the unconscious child. The initial assessment in children is in some ways more complex than in an adult. The airway is a more critical concern in the child. Airway obstruction is a more frequent cause of ventilatory insufficiency in pediatric trauma. Hypothermia is a vital concern because children lack the ability to maintain their temperature when they are compromised. Assessment of circulation and shock in children is complicated because the signs of shock are subtle in the child. The plan of care and the approach to the child must incorporate the child's fears and coping mechanisms based on the child's age and developmental level. Nursing diagnoses should reflect the plan of care not only for the child, but for his or her family. The proper approach to the child can positively influence the quality of the assessment, the level of cooperation, and the long-term outcome of care.

The primary survey of a trauma victim always begins with the ABCs used in resuscitation. Chest trauma compromises the normal physiology of respiration and circulation. Although some chest injuries are overt, some are not. The mechanism of injury is important for increasing the degree of suspicion used to identify covert injuries. The most lethal injuries include tension pneumothorax, sucking chest wound, massive hemothorax, flail chest, and cardiac tamponade. Cardiac and aortic ruptures often cause death before the victim enters the health care system. Potentially lethal injuries include myocardial and pulmonary contusion, tracheobronchial disruption, and esophageal disruption. Trauma victims present with many combinations of chest injuries. The care of these patients is very complex. Nursing diagnoses guide the care of chest trauma patients and can include impaired gas exchange, alteration in cardiac output, and altered breathing pattern. The goal of treatment is to restore and maintain stable hemodynamics with adequate respirations and circulation allowing definitive treatment for a positive patient outcome.

With the persistent presence of violence in our urban areas and the availability of guns, penetrating injuries as a result of firearm use continue to be a challenge for the emergency, surgery, and operating room nurse. Because gunshot wounds may be rapidly fatal, an understanding of firearms and the injuries they produce, as well as their possible complications, can assist the critical care nurse in caring for patients with gunshot wounds to the chest. Thoracic trauma is present in 50% of all trauma patients and is the cause of death in 25% of these victims. Penetrating trauma from violent episodes accounts for approximately 50% of cases of chest trauma in the urban setting.

As an OR staff nurse at Cook County Hospital, some of my most challenging and rewarding nursing experiences have come from caring for emergency open-chest trauma patients. From the moment we receive a call that an open-chest patient is on the way, everyone assigned is in a high state of tension. Every decision takes on exaggerated importance. The circulating nurse, by virtue of his or her position during an emergency, is the "hub of the wheel" of activity. He or she is privy to all facets of care that are being administered to the patient. The nursing challenge of the emergency open-chest trauma is great, but it is not an impossible task.