Chest Trauma 2 Flashcards
1
Q
Hemothorax
A
- Is an accumulation of blood in the intrapleural space.
- Frequently found with open pneumothorax and is then called hemopneumothorax.
** Caused by**
- trauma
- lung malignancy (pressure leads to the break of some of the blood supply),
- complication of anticoagulant therapy (high risk of bleeding),
- pulmonary embolus* (block structure and bleed the surrounding),
- tearing of pleural adhesions.
** Lung collapses as blood accumulates. **
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- If the blood flow is 300 ml/hr or more than 1500 ml/in total volume, it may require thoracotomy to correct hemorrhage or if less – chest tube.
- If volume is less than 300 ml. in total, leave to be absorbed.
- If eye is blown open/ or both eye blown open: deadly
2
Q
Fractured Ribs
A
- Localized pain over area on inspiration and tenderness on palpation
- Clicking sensation during inspiration
\> D/t the two ribs rubbing each other
- Shallow respirations
- Client holds self ie. Splinting
- May or may not have bruising
- Protruding bone splinters if a compound fracture
- Bright red sputum if lung is punctured.
Fractured Sternum
- Sharp stabbing pain
- Swelling & discolouration over the fracture site, crepitus (tissue paper)
3
Q
Flail Chest
A
- Fracture of two or more adjacent ribs on the same side.
\> All of them on the same size
- Causing an unstable chest wall.
- During inspiration, the affected portion is sucked in, and during expiration, it bulges out.
\> Inspiration: sucked in \> Expiration: bulges out
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INTERVENTION
- Initial therapy consists of adequate ventilation,
- Administration of humidified O2,
- Administration of crystalloid IV solutions,
- Pain control
- Definitive therapy is to re-expand the lung and ensure adequate oxygenation.
4
Q
Chest Tubes
A
Goal: To promote drainage of air and fluid to re-expand the lung and establish negative pressure. ** maybe tested
- To remove air and fluid from the pleural space and to restore normal intrapleural pressure so that the lungs can re-expand.
Position
> Anterior and/or posterior
- **Pneumothorax:** mid clavicle 2+3
\> chest tube high up
- : mid clavicle 8+9
\> chest tube lower down
5
Q
Chest Assessment on Chest Tubes
A
- VS: BP, temp, pulse, resp rate, O2 Sat
-
Ease of respiration
\> Watch the patient
- Chest pain
- Assess breathing effectiveness
- Assess for quality of O2 exchange and transport:> cyanosis, paleness, dyspnea, capillary refill
- Inspect jugular veins> Palpate;
Inspection
- Inspect chest wall for injuries: abrasions, bruising, wounds
- Observe chest wall for
- (place hands on posteriolateral chest wall with thumbs at the level of T9 or T10 with small fold of skin between thumbs)
6
Q
Management of CT & Pleur-Evac
A
- Keep tubing straight as possible and coiled below level of chest
- Keep suction control chamber and water seal chamber at appropriate water levels
- Mark time and level of drainage q8 hrs on drainage chamber
- Document tidalling(when pt breaths and water level goes up and down – if there is a block in the system, clot in the system there wont be tidalling) , presence of bubbling, characteristics of drainage
- Evacuate no more than 1000 1200 ml of fluid from pleural space to prevent rebound hypotension
- If Pleur-Evac is overturned, return to upright position and encourage pt to take deep breaths, followed by forced exhalations or coughing
7
Q
Troubleshooting
A
- Do not strip or milk chest tubes, studies have shown that milking the tubes increases the negative pressure in the intrathoracic cavity to -100 to -400 cm H2O
- If drainage system breaks, place distal end of tubing in a sterile water container at a 2 cm level as an emergency water seal
- If CT accidentally is pulled out, tape a sterile 4 X 4 dressing on three sides (leaving the bottom open) so air can still escape from chest wound
- Never clamp chest tubes, only clamped when Pleur-Evac has to be changed
- Tape all connections
