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Description
Flashcards by brittny beauford, updated more than 1 year ago
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Created by brittny beauford
almost 9 years ago
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| Question | Answer |
| Two major categories of chest trauma/thoracic injuries | Blunt: Body is stuck by a blunt object Penetrating Trauma: Foreign body impales or passes through body tissues. Open injury. |
| What is the primary management of a chest trauma/thoracic injury | Airway |
| In blunt force trauma what is acceleration/deceleration? | Example: car decelerates after hitting object but organs accelerate |
| Other factors to consider with blunt force traumas | shearing force (tissue riding over and ripping) crush/asphyxiation organ/lung damage underneath |
| S/S of Asphyxiation (crush) | Petechiae in the whites of the eyes, cheeks, face. Look at marking on the front and back of the patient. Crushing pressure can become systemic not just localized to injury |
| Examples of penetrating trauma | GSW (gun shot wound) stabbing impalement |
| ___________ is when there is air in the pleural space resulting in partial collapse of the lung. | Pneumothorax |
| With a pneumothorax the pressure in the lung goes from a ________ pressure to a ________ pressure | Negative Pressure → Positive Pressure |
| Clinical manifestations of a pneumothorax depend on size but include: | Respiratory Distress (shallow, rapid resps; dyspnea; air hunger; O2 desaturation) Chest pain cough ABSENT BREATH SOUNDS |
| the presence of lymphatic fluid in the pleural space due to a leak in the thoracic duct | Chylothorax |
| Blood in the pleural space, may or may not occur in conjunction with pneumothorax. | Hemothorax |
| The increased air in the pleural space shifts organs and increases intrathoracic pressure | Tension pneumothorax |
| How to treat a traumatic open (sucking) pneumothorax | 1. Ensure patent airway and administer 02 2.Get IV access and start fluids 3. Cover sucking chest wound with occlusive vented dressing taped on 3 sides Stabilize impaled objects. Don't remove. 4. Stabilize flail rib segment 5.If no spinal injury place pt in a semi-Fowler's position or what is easiest to breath. |
| This type of pneumothorax can occur due to laceration or puncture of the lung during medical procedures. Transthoracic needle aspiration is the leading cause | Iatrogenic pneumothorax |
| A _____________ pneumothorax typically occurs due to the rupture of small blebs (air-filled blisters) located on the apex of the lung. | spontaneous |
| Spontaneous pneumothorax is the rupture of Blebs or _______ in COPD, Asthma, Cystic Fibrosis, and Pneumonia patients. | Bullae (air or pus filled in PLEURAL SPACE) |
| Another name for spontaneous pneumothorax | closed pneumothorax |
| Why is it important to allow air to escape for a open pneumothorax? | Prevent tension pneumothorax, acts as a one way valve |
| The rapid accumulation of air in the pleural space without the ability to escape is a pneumothorax. What are early signs of this? | MOSTLY: SOB and TACHYCARDIA Also: dyspnea, O2 deceleration, decreased or absent breath sounds, diaphoresis |
| The rapid accumulation of air in the pleural space without the ability to escape is a pneumothorax. What are late signs of this? | NVD/JVD, cyanosis Unilateral movement of the chest and tracheal deviation |
| ____________ is when air escapes in the pleural space and goes into the SQ space. Crackles felt upon palpation. Signs of a pneumothorax. | Subcutaneous Emphysema |
| How much blood loss from a auto transfusion or chest tube is to much? | about a unit =16oz =450 mL |
| Causes of hemothorax include | Open Pneumothorax Trauma Malignancy Anticoagulant Therapy pulmonary embolus torn pleural adhesions |
| Causes of chylothorax include trauma, surgical procedures and malignancy. Therapy includes: | Conservative therapy: chest drainage bowel rest (increases tenfold after digestion of fats) parenteral nutrition Invasive therapy: surgery and pleurodesis (artificial production of adhesions between the parietal and visceral pleura) |
| Treatment of pneumothorax depends on severity. Collaborative care includes: | Preserve Hemodynamic stability CXR ABGs Chest-tube Heimlich/flutter valve: valve opens whenever the pressure in the chest is greater than atmospheric pressure. Ex. expiration needle venting |
| When a chest tube is set to water seal is it ok if there is persistent bubbling of air through the water? | No. Can bubble slightly with inspiration. Persistent bubbling indicates an air leak in the lung. Bubbling in the first 24 hours is more normal. |
| What can happen if a chest tube is clamped? | Tension pneumothorax. Should never be clamped. |
| Chest tubes can be water sealed, to gravity or connected to _________ | suction |
| The drainage bottle of a chest tube should always be kept ________ the level of the patient, otherwise its contents will siphon back into the chest cavity. | Below |
| Nursing management of a chest tube. What to look for | 1. Assess vital signs, lung sounds, and pain. 2. Assess for manifestations of reaccumulation of air & fluid in the chest (↓ or absent breath sounds) & signs of infection 3. Assess for SQ emphysema at tube site. 4. Encourage the patient to breathe deeply periodically to facilitate lung expansion and to prevent atelectasis or pneumonia |
| Drainage of a chest tube how much is to much? | Book: >100mL of drainage class: pint (450 mL) Consistency or color change should be reported to the physician |
| After a chest tube is removed should a CXR be performed? | yes |
| Most common type of traumatic chest injury | Fractured Ribs 5-10 most commonly fractured Remember whats underneath! |
| Two or more ribs in two or more separate locations will cause this | Flail chest |
| What type of movement is associated with flail chest? | Paradoxical movement: respiration are reversed, with the chest wall moving in during inspiration and out during expiration |
| 15% of all MVA deaths are due to this. It occurs due to a shearing or compression (between sternum and spine) | Aortic tear |
| Aortic tears can cause cardiac tamponade. What is cardiac tamponade? | Rapid collection of blood in the pericaridal sac, reducing filling |
| S/S of cardiac tamponade (medical emergency) | Muffled, distant heart tones ↓B/P NVD ↑CVP |
| Cardiac contusion what is the most common arrhythmia? | VTach |
| Drug of choice for hemothorax and why? | Toradal- NSAID- anti- inflammatory. No more then 5 days due to ulcers |
| Who can remove a chest tube? | Physician or APRN (unless patient is deceased) |
| What to do if a chest tube is disconnected or is pulled out? | Reconnect immediately. If its completely out cover with a 3 sided dressing |
| Cardiac Tamponade | Rapid collection of blood in the pericaridal sac, reducing filling |
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