Chest Trauma, Flail chest, management of chest tubes Flashcards
What is chest trauma?
when a patient experiences a blunt force or penetrating injury into the chest
what is flail chest?
3 or more consecutive fractured ribs in 2 or more places or fractured sternum and several consecutive ribs
what does flail chest cause?
causes unstable chest wall and paradoxical movement with breathing
could you explain to me how a chest will move when having flail chest?
inspiration - sucked in
expiration - bulges out
what are the 5 clinical manifestation of what you will see on a physical exam of a patient with a flail chest?
rapid, shallow respirations
asymmetric and uncoordinated chest movement
inadequate ventilation
splinting
crepitus near fractures
how do we diagnosis flail chest?
chest x-ray
what is the treatment of flail chest?
ensure adequate ventilation/lung expansion
adequate oxygenation
pain management
intubation/ mechanical ventilation
surgical fixation
( chest tubes this time )
chest trauma can cauise blood,fluid and air to go into places it does not belong to
can you tell me the 3 names and what they mean?
hemothroax - blood in pleural space
hemo-pneumothorax - blood and air in pleaural
chylothorax - lymphatic fluid in pleural space
what is the purpose of chest tubes and pleural drainage?
to remove air or fluid from pleural or mediastinal space
reestablished negative pressure
lung re-expands
pleural and or medistinal
how is a chest tube inserted?
mixacillary
hob 30-60 degrees, with arm rasied above head
small incision
sutured in place
connect to drainage
chest x-ray to confirm
how do we know a chest tube is properly in placed?
chest x-ray confirmation
there are two types of drainage systems, what are they?
water suction
dry suction
what are the 3 comparements chambers of a suction machine?
1, collection
2. water-seal
3, suction control
1st comparment or collection
- fluid stays in ; air vents out to 2nd
2nd compartment or water-seal chamber
- air goes in, bubbles out but cant go back to patient
3rd compartment or suction control chamber
- uses column of water to control suction from regulator
what is tidaling in water seal chamber
is it normal?
fluctuation of water with pressure changes during respirations is NORMAL
tidaing is normal during respiration
what is tidaling stops?
if stops suddenly, check for occlusion
is bubbling normal in the water seal chamber
and if so what are the expectations?
normal when first insertion
- intermittent - with exhalation,coughing, sneezing
what is bubbling continues even after several hours of insertion and they are no longer sneezing,coughing or exhalation ?
there is a possible leak
what is another form of chest tube we can give patients?
flutter or heimlich valve
whats the advantage of a heimlich or flutter valve for these patients?
increased mobility
they can go home on this
remember with a flutter valve, we must do what to avoid a tension penumothroax?
vent out to air
cut small slit in top of bag
how do we want to a drainage system to be?
on the ground
tubing loosely coiled
keep connections tight and taped
what are some things we want to assess for patients with a chest tube?
vital signs
lung sounds
pain
drianage amount
drainage site infection
subcutaenous emphysema
we want patietns to do what 2 things when having a chest tube in?
deep breathing/incentive spirometry
range of motion execises
