Critical Care Procedures Flashcards
Concepts of ATLS
- Treat greatest threat to life first
- Lack of a definitive diagnosis should never impede application of an indicated treatment
- Detailed history is not essential to begin evaluation of a patient with acute injuries
How to differentiate PTX from cardiac tamponade?
- Hyperresonance
- Deviated trachea
- Absent breath sounds over affected hemithorax
ABCDEs of trauma
Airway w/C-spine protection Breathing Circulation (stop the bleeding) Disability or neuro status Exposure and environmental
ATLS primary survey
ABCDEs
ATLS secondary survey
- Head to toe exam and history
- AMPLE (Allergies, Meds, Previous history, Last meal, Events/Environment)
Define simple PTX
Non-expanding collection of air around the lung
Diagnosis of simple PTX
- X ray typically needed
- Classic s/s are often difficult to appreciate
Define tension PTX
- One way valve leak
- EMERGENCY
Indications for needle decompression
Tension PTX leading to unstable patient
Complications of needle decompression
- Kinking of catheter
- Large body habitus
- Subsequent PTX
- Clot in catheter
- Lung laceration
ABCDs of chest x-ray
Airway Bone Cardiac Diaphragm Equal lung Fields Gastric bubble Hium
Possible complications of a chest injury
- ARDS
- Pulm contusion
- Aortic injury
- Bronchial tree injury
- Pericardial effusion
Indications for chest tube placement
- Post needle decompression
- Hemothorax
- Fluid
- Pus (empyema)
- Air
What is a large 30-40 French chest tube used for?
Evacuation of a hemothorax
What is a small 12-22 French chest tube used for?
Treatment of PTX
What are 9-12 French pigtail catheters used for?
Treatment of PTX
Larger French number = ?
Larger catheter diameter
Where is a chest tube placed?
4th or 5th ICS in mid-anterior axillary line
2nd ICS mid clavicular can be used for PTX or if a 2nd tube needs to be placed
Absolute contraindications for chest tube placement?
NONE
Relative contraindications for chest tube placement?
- Coagulopathy
- Prolonged PT time or thrombocytopenia
- Massive hemothorax
What can happen if all holes in chest tube are not within the pleural space?
Aspiration of air into surrounding soft tissue resulting in SQ emphysema (failed chest tube placement)
Why shouldn’t you incise at the bottom of the rib?
Bleeding due to NAV bundle
Describe water seal chamber
Water creates a 1 way valve that prevents air or fluid from returning to patient’s chest
Monitor water seal chamber for:
- Air leaks (bubbling)
- Tidaling (fluctuations in fluid level)
- Increased negative pressure
