Delayed respiratory deterioration post blunt chest trauma

Overview

Chest trauma is the second most common traumatic injury in non-intentional trauma. (Ludwig & Koryllos, 2017)

After blunt chest trauma patients are managed in a number of locations including the emergency department, the intensive care unit, a dedicated trauma unit, or orthopaedic, medical or surgical wards. Ongoing assessment and early identification of respiratory deterioration is crucial as patients who appear stable on early assessment may later deteriorate on the ward due to respiratory complications such as atelectasis and pneumonia.

A number of factors have been associated with a higher risk of respiratory complications post blunt chest trauma (Battle, Hutchings, James & Evans, 2013), including:

• number of ribs fractured (>3)
• age (>55 years)
• other serious injury such as head, extremity, abdominal, cardiac, or spinal cord injury
• smoking history or chronic lung condition.

Best practice management for the prevention and management of respiratory deterioration:

1. Regular monitoring and patient assessment.
2. Early identification of at-risk patients and signs of respiratory deterioration, such as:
   1. early warning scores (EWS)
   1. PIC score algorithm (pain, inspiration, cough). (Witt & Bulger, 2017)
3. Effective pain management.
4. Optimisation of lung volumes and cough effectiveness through upright positioning and chest physiotherapy.
   1. Incentive spirometry devices can be used as a visual aide to teach optimal deep breathing technique (slow, deep breath with inspiratory hold).
   1. Poor performance of incentive spirometry (volumes <1L) may be predictive of higher risk of respiratory complications. (Sadler, Burgess, Dougherty & Collins, 2019)
5. Multidisciplinary care and communication.  

Description

This resource kit provides healthcare workers with useful resources and key practice points to assist them to identify and manage respiratory complications in patients following blunt chest trauma injuries.

Learning objectives

• Identify patient and injury-related factors that place a patient at greater risk of delayed respiratory complications post chest trauma.
• Identify three key signs of impending respiratory deterioration – poorly controlled pain, impaired inspiration, and impaired cough.
• Demonstrate the skill of teaching a patient the correct incentive spirometry technique.

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