Diaphragmatic Trauma (Nursing)

00:00 Now we also have a scale and this will help us kind of grade how intense the injury is to the diaphragm. So they call it the diaphragmatic injury scale. Grade 1 is just a contusion or a bruise.

00:13 Grade 2 is a laceration that's smaller or equal to 2 cm. Grade 3 is 2 cm to 10 cm, 4 is greater than 10 and you've got some tissue loss. Grade 4 is a laceration and a pretty significant tissue loss. So this is just a one way that we use to communicate as healthcare providers that helps us communicate the severity of the injury of the diaphragm. Grade 1 is going to have a much smoother and quicker recovery than obviously a 2, 3, 4, or 5. So, what are the ways your diaphragm is traumatized. Well, you can have direct impalement. That's a penetrating injury.

00:58 So the patient is stabbed, they suffer a gunshot, or they're impaled with something else that goes through the diaphragm. Now an indirect contusion is more like a car accident. You see we have a picture of a car and the 3 meeting there, more of a blunt trauma injury. Motor vehicle accidents, a fall, or some type of crushing injury is usually often more of an indirect contusion.

01:20 And here's an interesting point. The left side of the diaphragm is more likely to be injured with blunt trauma. So, if you're working in an ER you'll definitely get to see this in person. Now I want to talk about 3 types of complications from trauma to the diaphragm. Herniation, that's when things are going to start squishing through the diaphragm; diaphragm paralysis; and pulmonary complications. So if you have a patient who's experienced trauma, these are 3 categories of types of complications that can come from trauma. So let's look at herniation first. Now, the left side, if you have a herniation on the left side, remember that's a separation of that muscle, you can have a possible herniation of the stomach. Okay, that makes sense because we know that tucked up on the left side is the stomach. So that's also why the spleen, the colon, the small intestine, or the omentum are also possibilities. Those are more on the left side. On the right side, we know the organ that's tucked up in there. In the right side is the liver. So if I have a herniation in my diaphragm, a separating of that muscle wall, I could have the liver or the colon slide up into that separation. Now, last, if you have cardiac herniation, has also been reported. Usually from a super high speed collision. So, left side, you think of more of the stomach and those contents. Right side, liver or the colon and cardiac herniation is rare, but it has been seen if someone has a super fast high speed collision. Okay, so that's herniation. Let's talk about diaphragm paralysis. Now the diaphragm is responsible for 75%-80% of your tidal volume. That means, the amount of volume, the size of the breathe that you can breathe in. So it's responsible for the largest portion of that volume, 75%-80%.

03:24 So, if that diaphragm is paralyzed, you know that the impact is going to be significant on my ability to take a normal size or adequate breath. Can also be paralyzed from phrenic nerve injury. If it's irritated, if it's traumatized, the diaphragm is going to suffer from paralysis.

03:42 Now the pulmonary complications, see if a diaphragm injury is also accompanied by some type of rib fracture and if they have a rib fracture then they probably have pulmonary contusion so those seem to go along. Diaphragm injury often has a rib fracture associated with it. If they have a rib fracture have also had a pulmonary contusion. Remember that's kind of bruising or bleeding into the tissue of the lungs. So when I receive a patient, let's say I'm working in ER or I'm working in a critical care unit or on a telemetry unit, when I receive a patient who's had a car accident I'm going to be thinking about these 3 things. Do I see any signs of herniation? How well is their diaphragm functioning? And what could be the possible pulmonary complications along with this injury?