The patient’s findings are consistent with a ruptured diaphragm, which is a tear in the muscle that separates the chest and abdominal cavities. A blunt chest trauma can cause a sudden increase in intra-abdominal pressure, which can rupture the diaphragm and allow abdominal organs to herniate into the thorax. This can cause dyspnea, hypotension, shoulder pain, and bowel sounds over the lower thorax. A ruptured abdominal viscus would cause peritonitis, which would present with abdominal pain, distension, fever, and signs of sepsis. A flail chest would cause paradoxical chest movement, respiratory distress, and cyanosis. A mediastinal shift would cause tracheal deviation, decreased breath sounds, and jugular venous distension.
References:
AACN. (2023). CCRN (Adult) Exam Handbook. Retrieved from [CCRN Exam Handbook], p. 18.
AACN. (2023). CCRN (Adult) Exam Blueprint. Retrieved from [CCRN Exam Blueprint], p. 2.
BCEN. (2020). Trauma Certified Registered Nurse (TCRN) Examination Content Outline. Retrieved from [TCRN Exam Content Outline], p. 8.
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). Medical-surgical nursing: Assessment and management of clinical problems (11th ed.). St. Louis, MO: Elsevier. Retrieved from [Textbook], p. 1789-1790.
