Blunt chest trauma is damage caused to the thoracic cavity or lungs that causes rib fractures or pulmonary contusions. This could also cause pneumo or hemothoraces, which are discussed in a separate lesson/careplan. Rib fractures can cause significant pain, which will impair the patient’s ability to breathe deeply. This shallow breathing can lead to atelectasis and pneumonia. Pulmonary contusions are lung bruises that cause swelling and fluid collection in and around the alveoli, and therefore impair gas exchange. Just like a typical bruise, these tend to get worse before they get better.
The most common causes of blunt chest trauma are motor vehicle collisions, falls, being hit in the chest by something (i.e. heavy machinery), or explosions (due to the shockwave).
Optimize oxygenation and gas exchange and prevent atelectasis by promoting full lung expansion. Manage the patient’s pain to ensure deep breathing.
Monitor respiratory rate, depth, and character
Patients with rib fractures tend to take more frequent, shallow breaths instead of steady, deep breaths. This is typically due to the pain on inspiration.
Shallow breaths can lead to atelectasis and pneumonia.
Monitor SpO2 and ABG if available
Patients with pulmonary contusions are at risk for developing excessive fluid and swelling within their lungs. This can impair oxygenation and gas exchange. Often this condition is worse on days 2-4, so we must monitor for possible decompensation.
Auscultate the patient’s lungs
Crackles or wheezes may be heard with pulmonary contusions or if the patient develops pneumonia.
Diminished breath sounds may be an initial indicator of the development of atelectasis
Administer supplemental O2 as needed
Patients are at risk for impaired oxygenation. We should support them with supplemental oxygen as needed, starting with the least invasive method (nasal cannula).
Pain can cause the patients to take more shallow breaths, which can lead to atelectasis. Addressing their pain can make it easier for them to take deep breaths and perform chest expansion exercises.
Educate the patient on the use of a pillow for splinting
Splinting can help decrease the pain associated with deep breathing and coughing, especially for patients with rib fractures.
Educate the patient on chest expansion exercises:
Incentive Spirometry and Deep breathing/coughing can help to open any collapsed alveoli and prevent further atelectasis. Incentive spirometry should be done every hour while awake.
Advocate for higher level of care if patient decompensating
Patients with pulmonary contusions may decompensate on days 2 – 4. If you feel your patient is getting worse, call a Rapid Response and advocate to get them transferred to a higher level of care if appropriate.
For more information, visit www.nrsng.com/cornell
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