Client experienced chest trauma. Transported from disaster scene via stretcher. The right and left sides of their chest are moving unevenly during respirations. Heart rate is 78/min and regular, respiratory rate is 34/min and shallow. Client receiving oxygen at 6 ?L/min via face mask.
0901:
Assessment:
Client is alert and does not follow commands during assessment.
0905:
Assessment:
Respirations slowed, then stopped. Client’s head repositioned and shallow respirations resumed at 30/min. ?Breath sounds on the right are diminished.
Capillary refill is 3 ?seconds. (Peripheral pulses are 1+.)
0900:
Report from EMS:
Client experienced chest trauma. Transported from disaster scene via stretcher. The right and left sides of their chest are moving unevenly during respirations. Heart rate is 78/min and regular, respiratory rate is 34/min and shallow. Client receiving oxygen at 6 ?L/min via face mask.
0901:
Assessment:
Client is alert and does not follow commands during assessment.
0905:
Assessment:
Respirations slowed, then stopped. Client’s head repositioned and shallow respirations resumed at 30/min. ?Breath sounds on the right are diminished.
Capillary refill is 3 ?seconds. (Peripheral pulses are 1+.)
The Correct Answer and Explanation is :
The scenario indicates a client with uneven chest movement during respirations, diminished breath sounds on the right, shallow and irregular breathing, and a history of chest trauma. These findings strongly suggest a flail chest or pneumothorax as the primary condition.
Correct Answer:
The client is likely experiencing a flail chest and/or a pneumothorax, possibly tension pneumothorax.
Explanation:
Clinical Findings:
- Uneven chest movement: This is a hallmark sign of flail chest, where multiple rib fractures cause a segment of the chest wall to move paradoxically during respiration.
- Diminished breath sounds on the right: Suggests impaired lung expansion on that side, likely due to a pneumothorax (collapsed lung), hemothorax (blood accumulation), or both.
- Shallow and irregular respirations: Indicates respiratory distress and potential hypoxia due to impaired gas exchange.
- Capillary refill of 3 seconds and 1+ pulses: Suggest compromised perfusion, a sign of shock or hypoxia.
- Respirations stopped and resumed after repositioning: Suggests airway compromise or inadequate oxygenation.
Immediate Concerns:
- Hypoxia: The shallow, rapid breathing and diminished lung sounds on the right compromise oxygen delivery.
- Tension pneumothorax: If a pneumothorax progresses, it can lead to increasing intrathoracic pressure, compressing the heart and other lung, causing rapid deterioration.
Interventions:
- Oxygenation: Ensure high-flow oxygen, preferably using a non-rebreather mask or consider assisted ventilation with a bag-valve mask if necessary.
- Chest decompression: If tension pneumothorax is suspected, immediate needle decompression should be performed, followed by chest tube insertion.
- Stabilization of flail chest: Secure the flail segment (e.g., manual pressure, bandaging) and ensure adequate analgesia to prevent hypoventilation due to pain.
- Monitoring: Continuous assessment of vital signs, oxygenation, and perfusion is critical.
This case underscores the importance of rapid identification and intervention for life-threatening chest injuries to prevent respiratory failure or shock.