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Trauma and Trauma Systems > breathing and ventilation > Flashcards

breathing and ventilation Flashcards

1
Q

ribs

A
  • 12 pairs
  • 10 pairs attach to sternum and spine
  • 2 pairs (floating ribs) attach only in back
  • an intercostal nerve, artery, and vein are found along the inferior border of each rib
  • IPASSO2- inspect chest (symmetry), palpate, seal on both sides, auscultate in four places
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2
Q

mediastinum

A
  • trachea
  • esophagus
  • main bronchi
  • heart
  • major arteries- aorta and branches; and pulmonary arteries
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3
Q

physiology of life review

A
  • oxygen is transported across the alveolar-capillary membrane
  • it then attaches to hemoglobin in RBCs for transport to the rest of the body
  • at the same time CO2 moves from the blood plasma into the alveoli
  • pH goes down
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4
Q

breathing

A
  • the mechanical act of moving air into the lungs and alveoli
  • controlled by the respiratory center of the brain
  • chemoreceptors located in the aorta and carotid arteries stimulate the respiratory center
  • rate and depth of ventilation are continuously adjusted to maintain normal PaCO2 levels
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5
Q

breathing assessment

A
  • normal breathing is not a noticeable process
  • if the pt breathing draws your attention then there is problem until proven otherwise
  • ex.
  • breathing you can hear from across the room
  • inability to speak in complete sentences
  • patient position to ease breathing (tripoding)
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6
Q

steps of breathing assessment

A
  • look (observe)
  • listen (auscultate)
  • feel (palpate)
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7
Q

look/observe

A
  • increased respiratory effort
  • positioning
  • use of accessory muscles
  • retractions
  • nasal flaring in children
  • visible signs of trauma
  • contusions
  • hematomas
  • lacerations
  • sucking chest wound
  • paradoxical movement of the chest wall- ribs broken and you can see it -> chest moves out during exhalation and inward during inhalation
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8
Q

listen (auscultate)

A
  • presence
  • equality (symmetry on left and right)
  • asymmetry
  • decreased on one side
  • absent sound on one side
  • listen for full cycle- inhale and exhale
  • wheezing
  • rales
  • rhonchi
  • crepitus- bony or subcutaneous emphysema
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9
Q

feel/palpate

A
  • bony crepitus- broken ribs
  • subcutaneous emphysema
  • abnormal movement of the chest wall
  • bony tenderness
  • does it hurt to touch
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10
Q

pneumothorax

A
  • simple- collapsed lung
  • tension- pressure is building up -> more collapsed
  • open- caused by the hole on the chest
  • present in up to 20% of severe chest injuries
  • a simple pneumothorax may progress to a tension pneumothorax as air continues to accumulate within the affected hemithorax
  • tension pneumothorax is life threatening
  • needle decompression may be required for tension pneumothorax
  • may be associated with hemothorax
  • tube can be used to suction out air or blood
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11
Q

hemothorax

A

-blood in the chest

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12
Q

rib fractures

A
  • simple

- flail chest

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13
Q

simple pneumothorax vs tension pneumothorax

A
  • simple
  • blunt or penetrating injury
  • breath sounds decreased or absent
  • mild to moderate ventilatory distress
  • may progress to tension
  • tension
  • blunt or penetrating injury
  • breath sounds decreased or absent
  • marked ventilatory distress
  • hemodynamic compromise -> prevents blood flow -> obstructive shock
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14
Q

open pneumothorax

A
  • penetrating mechanism
  • may be sucking or bubbling chest wounds
  • respiratory distress- mild to severe
  • may be associated with a hemothorax
  • optimal method of field management has not been demonstrated
  • visceral and parietal pleura -> pressure builds and moves things to the other side
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15
Q

hemothorax

A
  • blunt or penetrating mechanism
  • bleeding into the pleural cavity
  • may be associated with a pneumothorax
  • air or blood in the pleural space compromises lung capacity
  • could be arterial bleeding under pressure
  • chest can handle holding a lot of blood
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16
Q

simple rib fractures

A
  • most common thoracic injury
  • usually involves ribs 4-8, laterally
  • most common cause of hemothorax
  • common complaints are chest pain and shortness of breath
  • may be associated with injuries to liver and spleen
  • hypoventilation bc of pain
17
Q

flail chest

A
  • two or more adjacent ribs fractured in more than one place
  • compromises the structural integrity of the chest, causing paradoxical movement while breathing
  • segments move inward during inhalation
  • and segments move out during exhalation
  • positive pressure ventilation helps with moving the segments along with the chest
  • associated with underlying injuries:
  • pneumothorax, hemothorax, pulmonary contusion
18
Q

treatment of chest injuries

A
  • the goal is to maintain or restore adequate oxygenation and ventilation
  • administer supplemental oxygen
  • assist ventilation as necessary
  • seal open chest wounds
  • recognize and decompress tension pneumothorax
  • continuous assessment of breathing is essential
19
Q

supplemental oxygen

A
  • can be administered by nonrebreathing mask, a BVM, or an oxygen powered ventilation
  • BVM is much better bc it can get a sense of chest compliance -> if its getting harder you can tell pressure is building up
  • never withhold oxygen from apt is respiratory distress
  • monitor oxygen saturation
  • target SpO2 greater than 95%
  • increasing the levels of inspired oxygen assists in maintaining aerobic metabolism
20
Q

when to assist ventilations

A
  • ventilatory rate- greater than 30 (and especially shallow) and less than 10
  • insufficient spontaneous tidal volume- poor chest rise and use of accessory muscles
  • decreased SpO2
  • increased ETCO2 -> retaining CO2
  • consider the need for airway management
21
Q

ventilatory rates and tidal volume for adults

A
  • 10-12 breaths per minute

- 500-800 ml

22
Q

ventilatory rates and tidal volume for child

A
  • 16-20

- 100 to 500 ml or until good chest rise

23
Q

ventilatory rates and tidal volume for infant

A
  • 25
  • 6-8 ml/kg volume
  • inadvertent hyperventilation may lead to poor outcomes in patients with a traumatic brain injury
24
Q

tidal volume delivery

A

-6-7 ml per kg

25
Q

capnometry and capnography

A
  • monitors:
  • spontaneously breathing patient
  • bag mask device
  • endotracheal tube
  • supraglottic airways
  • maintain between 25 to 45 mm Hg
  • may give false reading in hypotension but can be used to monitor trends
26
Q

needle decompression

A
  • used to relieve tension pneumothorax
  • appropriate placement is essential
  • secondary intercostal space, midclavicular line, over the rib (preferred site)
  • fifth intercostal space, midaxillary line, over the rib (alternate site)
  • over the rib is always better
27
Q

summary

A
  • Caring for a trauma patient experiencing respiratory difficulty includes:
  • Maintaining a patent airway
  • Administering supplemental oxygen
  • BVM is the best way
  • Supporting and monitoring ventilations
  • Recognizing and decompressing tension pneumothorax
28
Q

CO2

A
  • CO2 rising-> ventilate more

- monitoring CO2 tells you that your airway management is working and is in the right position

Trauma and Trauma Systems (18 decks)

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