Nursing Care of Patient with Penetrating Chest Injury (Left Chest Wall)

Revathy¹, Priya², Vaishna Abi ³

¹Emergency Ward Nursing Incharge, Kauvery Heartcity, Trichy, India

²Emergency Ward Senior Staff Nurse, Kauvery Heartcity, Trichy, India

³Emergency Ward Staff Nurse, Kauvery Heartcity, Trichy, India

Abstract

A 31 years old patient came with the complaints of stab injury. Initially went to an another hospital and then came to KHC for further management. Chest trauma is one of the serious injuries and one of the leading causes of death from physical trauma. The current study is designed to study clinical profile, patterns of injury, causes, complication, treatment required in chest trauma management. This is a prospective observation study conducted at Kauvery Heartcity.

Background

Chest trauma has quickly risen to be the second most common traumatic injury in non-intentional trauma. Trauma to the chest is also associated with the highest mortality in some studies, upto 60%, depending on the mechanisms of injury. While penetrating chest trauma is less common than blunt trauma, it can be more deadly. Quick thinking and early intervention are key factors for evaluation, management and survival.

Case Presentation

A 31 years male patient presented with assault by a known person. He had a stab injury over the left side of chest, trace to mild circumferential pericardial effusion and normal LV function. He was to have both DM and HTN. The patient was admitted for further management. On examination, he was conscious and irritable.

Vitals: BP -100/60 mm of Hg

Pulse: 112/mt

Pain score: 4/10

ECG: Sinus tachycardia, rate 99. Consider left artrial enlargement.

ECHO

Trace to mild circumferential pericardial effusion,

No 2D/Doppler evidence of cardiac tamponade.

Normal LV systolic function

Scan Image (Injury)

X – Ray image

Before Image

After Image

Immediate care

After receiving the patient we stabilized him and assessed the bleeding site.
As preventive measure Inj.Pantocid 40mg iv stat Inj.Emeset 4mg IV stat was administered.
Vital signs assessed and found painscore:4/10, BP:100/60mmHg; HR:112/mt.
Immediately started IV Fluids and Inj.Nor Adrenaline infusion was titrated according to the patient’s blood pressure.
Examined the patient’s skin, found intact.
Duty doctor explained the condition to the attenders.
High risk consent obtained.
Evaluated the injury site and dressing was done.
Patient was under continuous monitoring.
Obtained the cardiology and cardio thoracic vascular surgeon opinion. ECG, ECHO and CT Aorta gram taken.
Patient was shifted to CCU 1 for further management.

Nursing Management

Patient shifted to critical care unit1 with duty doctor and continuous cardiac monitoring.
Nurses maintained an every 15mts B.P chart. BP was stabilized with Inotropes and IV fluids.
Nurses skilled in IV infusion and blood sampling techniques (Phlebotomy) obtained the samples for blood investigations like CBC, ESR, Sodium, Potassium, RFT, Blood Grouping, CT Aorta gram, Chest X-Ray, LFT,CT Chest, Endotracheal culture, Typing serology with a sterile technique to prevent thrombophlebitis.
Doctors explained the patient’s condition to the attenders. Nurses obtained consent for the clinical procedures after proper counseling.
Nurses used AIDET technique (Acknowledge, Introduce, Duration, Explanation and Thank you) while communicating with patient and attenders to gain their confidence and improve the satisfaction level.
Patient was successfully extubated after weaning SPO2 was 97%in room air.
Diagnosis: Penetrating chest injury.
Recommendation plan: Medical stabilization
Patient stabilized and shifted to ward on 13.09.2022 drug orders followed as per doctor’s advice.
Patient discharged on 14.09.2022.

Discharged advice

Diet advice
Medication advice
Daily activity advice
Review after 2weeks

Outcome

On discharge patient was hemodynamically stable.

Discussion

The patient received the most appropriate care for his Penetrating Chest Injury.

Medico legal cases:

This stab injury case came under medico Legal Case (MLC).
As per protocol intimation was given, Accidental record (AR copy) was done by Duty doctor.
One MLC copy attached to the case sheet; one copy given to the patient’s attendant and one to the police.

Ms. Revathy

Emergency Ward Incharge

Ms. Priya

Emergency ward Senior Staff Nurse

Ms. Vaishna Abi

Emergency Ward Staff Nurse

Nursing Care of Patient with Penetrating Chest Injury (Left Chest Wall)