Flail chest.

Following standard weaning protocols, including sedation interruptions and spontaneous breathing trials, Mrs. W is successfully weaned from the mechanical ventilator and extubated on day 5 of hospitalization. Mrs. W is also weaned off of the PCA and achieves acceptable pain control with oral analgesic agents. Following education about the importance of nutrition, hydration, deep breathing, and aggressive mobility, she's discharged to a rehabilitation facility on day 8. She remains at this facility for 2 weeks, where she continues to be educated on using analgesics for pain control and mobilizing safely at home.

Flail chest: a nursing challenge.

Caring for a patient with a flail chest poses a significant challenge to the ED nurse. Performing serial evaluation, complicated pain management, and diligent pulmonary toilet will put your nursing skills to the test! Finding the time to do it in a busy emergency department ... well, that's a topic for another article.

Chest injuries in the trauma patient.

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.

Thoracic trauma. Nursing assessment and management.

The importance of the respiratory system to total body functioning cannot be overemphasized. It is imperative that the nurse realize that the first priority in trauma care is to maintain and support the respiratory system. The nurse must be able to rapidly and effectively perform a primary survey, recognize the clinical manifestations of life-threatening thoracic injuries, and intervene in the care of the patient to help stabilize and maintain the patient's respiratory function. The nurse must not only be able to asses, but must also be able to technically intervene rapidly and effectively. Other potential life-threatening injuries must remain uppermost in the nurse's mind. Continual, ongoing monitoring of the patient's status must be an integral part of the nurse's actions. If these activities are judiciously employed, perhaps the mortality rate will decrease and the thoracic trauma victim will survive, capable of leading a full and productive life in our society. This is quality patient care.