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    Stab Wound Pathophysiology

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    Jaessa Feliciano
    A stab wound to the chest can cause a pneumothorax or hemothorax as it may puncture the lung or damage blood vessels in the chest. Symptoms include chest pain, shortness of breath, and difficulty breathing. Diagnostic tests include chest x-rays and CT scans to detect air or blood in the pleural space surrounding the lungs. Treatment involves inserting a chest tube to drain air or fluid and reinflate the lung. Patients are monitored for complications and taught signs of infection or worsening symptoms to watch for after discharge.

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    Stab Wound Pathophysiology

    Uploaded by

    Jaessa Feliciano
    3K views5 pages
    A stab wound to the chest can cause a pneumothorax or hemothorax as it may puncture the lung or damage blood vessels in the chest. Symptoms include chest pain, shortness of breath, and difficulty breathing. Diagnostic tests include chest x-rays and CT scans to detect air or blood in the pleural space surrounding the lungs. Treatment involves inserting a chest tube to drain air or fluid and reinflate the lung. Patients are monitored for complications and taught signs of infection or worsening symptoms to watch for after discharge.

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    A stab wound to the chest can cause a pneumothorax or hemothorax as it may puncture the lung or damage blood vessels in the chest. Symptoms include chest pain, shortness of breath, and difficulty breathing. Diagnostic tests include chest x-rays and CT scans to detect air or blood in the pleural space surrounding the lungs. Treatment involves inserting a chest tube to drain air or fluid and reinflate the lung. Patients are monitored for complications and taught signs of infection or worsening symptoms to watch for after discharge.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    3K views5 pages

    Stab Wound Pathophysiology

    Uploaded by

    Jaessa Feliciano
    A stab wound to the chest can cause a pneumothorax or hemothorax as it may puncture the lung or damage blood vessels in the chest. Symptoms include chest pain, shortness of breath, and difficulty breathing. Diagnostic tests include chest x-rays and CT scans to detect air or blood in the pleural space surrounding the lungs. Treatment involves inserting a chest tube to drain air or fluid and reinflate the lung. Patients are monitored for complications and taught signs of infection or worsening symptoms to watch for after discharge.

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    of 5

    PATHOPHYSIOLOGY

    STAB INJURY

    Predisposing factors:

    Precipitating factors:

    Environment where pt lives


    Environment where the pt works
    for a living
    Shift of work (night)
    Relationship with other people

    Age. More common in


    young adults
    Gender. More common in
    males

    CHEST INJURY DUE TO STAB WOUND


    (PNEUMOHEMOTHORAX)

    Etiology:
    A stab wound is a specific form of penetrating trauma to the skin that results from a knife or a similar pointed object
    that is "deeper than it is wide. Any blunt or penetrating injury to your chest can cause lung collapse. Some injuries
    may happen during physical assaults or car crashes, while others may inadvertently occur during medical procedures
    that involve the insertion of a needle into the chest. But the most common form of pneumothorax and hemothorax,
    caused by open or closed chest trauma related to blunt or penetrating injuries

    Excessive loss of blood

    Rapid increase of pressure in


    chest due to compression of the
    vena cava with impaired
    venous return to the heart

    Decreased blood
    supply to the body

    Rupture of blood vessel


    in the thorax

    Air and blood enters the


    pleural space

    Accumulation of air and blood


    in the pleural space

    Penetration into pleural space


    by an object external to the
    chest wall

    Injury to the chest wall

    Increase intrathoracic pressure


    and reduction in vital capacity

    Decreased oxygen
    supply to the body

    Decrease in lung expansion

    Obstruction of air going into


    and out of the alveoli

    Impaired Gas
    Exchange

    DYSPNEA

    Increase use of
    accessory muscles

    Signs and Symptoms:


    Symptoms of a pneumothorax include chest pain that usually has a sudden onset. The pain is sharp and
    may lead to feelings of tightness in the chest. Shortness of breath, rapid heart rate, rapid breathing,
    cough, and fatigue are other symptoms of pneumothorax. The skin may develop a bluish color (termed
    cyanosis) due to decreases in blood oxygen levels. But these symptoms can be caused by a variety of
    health problems, and some can be life-threatening. If your chest pain is severe or breathing becomes
    increasingly difficult, get immediate emergency care.
    Physical Exam:
    Asses for:
    Absent breath sounds on affected lung
    Cyanosis
    Decreased chest expansion unilaterally
    Dyspnea
    Hypotension
    Sharp chest pain
    Subcutaneous emphysema as evidenced by crepitus on palpation
    Sucking sound with open chest wound
    Tachycardia
    Tachypnea
    Tracheal deviation to the unaffected side with tension pneumothorax

    Diagnostics/ Imaging studies:

    Thoracic CT: Studies show that CT is more sensitive than x-ray in detecting thoracic injuries,
    lung contusion, hemothorax, and pneumothorax. Early CT may influence therapeutic management.
    Chest x-ray: Reveals air and/or fluid accumulation in the pleural space; may show shift of
    mediastinal structures (heart).
    Chest radiography: To rule out penetration of the chest cavity
    Abdominal radiography in 2 views (anterior-posterior, lateral). To determine any organ affected
    in the abdomen
    Chest and abdominal ultrasonography: Focused assessment with sonography for trauma
    (FAST); includes 4 views (pericardial, right and left upper quadrants, pelvis)
    Abdominal CT scanning (including triple-contrast helical CT): Most sensitive and specific study
    in identifying and assessing liver or spleen injury
    Thoracentesis: Presence of blood/serosanguineous fluid indicates hemothorax.

    Laboratory Testing:
    All patients with chest trauma/pneumohemothorax and possible abdominal trauma should undergo certain
    basic laboratory testing, especially if emergent operation is necessary:

    Blood type and cross-match


    Complete blood count (CBC)
    Electrolyte levels
    Blood urea nitrogen (BUN) and serum creatinine level
    Glucose level
    Prothrombin time (PT)/activated partial thromboplastin time (aPTT)
    Venous or arterial lactate level
    Calcium, magnesium, and phosphate levels
    Arterial blood gas (ABG)
    Urinalysis
    Serum and urine toxicology screen
    Possible complications:

    Another collapsed lung in the future


    Shock
    Hypoxemia
    Respiratory failure and
    Cardiac arrest

    Nursing Management:
    Assess and monitor for:

    Airway, breathing, circulation (ABCs)


    Signs of tachycardia, dyspnea, hypotension, etc.
    Vital signs, including the pulseoximetre
    I and O
    Level of consciousness to detect neurologic deficits
    Location(s) of the wound(s): Inspect all body surfaces, and document all penetrating wounds
    Type of penetrating weapon or object
    Amount of blood loss
    Apply a dressing over an open chest wound.
    Administer oxygen as prescribed.
    Position the client in high fowlers position.
    Prepare for chest tube placement until the lung has expanded fully.
    Monitor chest tube drainage system.
    Monitor for subcutaneous emphysema.
    Medical Management:

    The priority is to maintain airway, breathing, and circulation. The most important interventions focus on
    reinflating the lung by evacuating the pleural air. Patients with a primary spontaneous pneumothorax that is
    small with minimal symptoms may have spontaneous sealing and lung re-expansion.
    For patients with jeopardized gas exchange, chest tube insertion may be necessary to achieve lung reexpansion.
    Maintain a closed chest drainage system; be sure to tape all connections, and secure the tube carefully at the
    insertion site with adhesive bandages. Regulate suction according to the chest tube system directions;
    generally, suction does not exceed 20 to 25 cm H2O negative pressure.
    Monitor a chest tube unit for any kinks or bubbling, which could indicate an air leak, but do not clamp a
    chest tube without a physicians order because clamping may lead to tension pneumothorax.
    Stabilize the chest tube so that it does not drag or pull against the patient or against the drainage system.
    Maintain aseptic technique, changing the chest tube insertion site dressing and monitoring the site for signs
    and symptoms of infection such as redness, swelling, warmth, and drainage.
    Oxygen therapy and mechanical ventilation are prescribed as needed. Surgical interventions include
    removing the penetrating object, exploratory thoracotomy if necessary, thoracentesis, and thoracotomy for
    patients with two or more episodes of spontaneous pneumothorax or patients with pneumothorax that does
    not resolve within 1 week.
    Foley catherization: to monitor fluid resuscitation
    Pharmacotherapy:
    Tube thoracostomy: to relieve hemothorax/pneumothorax
    Thoracentesis:
    procedure
    in used
    whichina the
    needle
    is inserted through
    the back
    the chest
    wall into the pleural
    The following
    medications
    may be
    management
    of patients
    withofchest
    trauma:
    space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air.

    Analgesics (eg, morphine sulfate, fentanyl citrate)


    Anxiolytics (eg, lorazepam, midazolam hydrochloride)
    Antibiotics (eg, cefotetan, metronidazole hydrochloride, gentamicin sulfate, vancomycin
    hydrochloride, ampicillin sodium-sulbactam sodium)
    Neuromuscular blocking agents (eg, succinylcholine, vecuronium bromide)
    Immune enhancement (eg, tetanus toxoid adsorbed or fluid)

    ** No routine pharmacologic measures will treat pneumothorax, but the patient may need
    antibiotics, local anesthesia agents for procedures, and analgesics, depending on the extent and
    nature of the injury. **

    Discharge Goals:

    Adequate ventilation/oxygenation maintained.


    Complications prevented/resolved.
    Pain absent/controlled.
    Disease process/prognosis and therapy needs understood.
    Plan in place to meet needs after discharge.

    Discharge and Home Healthcare Guidelines:

    Review all follow-up appointments, which often involve chest x-rays, arterial blood gas analysis,
    and a physical exam. If the injury was alcohol-related, explore the patients drinking pattern.
    Refer for counseling, if necessary. Teach the patient when to notify the physician of complications
    (infection, an unhealed wound, and anxiety) and to report any sudden chest pain or difficulty
    breathing.

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