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Med Procedures Quiz 2 > Critical Care Procedures > Flashcards

Critical Care Procedures Flashcards

1
Q

Three concepts of ATLS

A
  1. Tx the greatest threat to life 1st
  2. The lack of a definitive dx should never impede the application of an indicated tx
  3. A detailed hx is not essential to begin the evaluation of a patient with acute injuries
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2
Q

ABCDE

A 
A - airway w/C-spine protection
B - breathing
C - circulation, stop the bleeding
D - disability or neuro status (AVPU)
E - exposure (undress pt) & environment (temp control of the room)
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3
Q

8 MC life threatening breathing conditions

A
  • airway obstruction
  • tension ptx
  • spontaneous ptx
  • hemothorax
  • flail chest
  • aortic injuries
  • cardiac tamponade
  • pulmonary contusions
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4
Q

Primary Surveys

A

-Who, What, Where?

Non response to these questions suggests the patient has abnormalities to ABCD and warrants urgent intervention

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5
Q

Secondary Surveys

A

-Begin when the primary survey is complete, resuscitative measures are underway and vitals are stabilizing

**SHOULD NOT INTERFERE WITH A PRIMARY SURVEY, WHICH TAKES FIRST PRIORITY.

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6
Q

Secondary Survey pneumonic

A

AMPLE

  • allergies
  • meds
  • past hx/preg
  • last meal
  • events/environment related to the injury
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7
Q

Parietal pleura

A

Lines the outer layer of the thoracic cavity

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8
Q

Pleural space

A

The small potential space between the parietal and visceral layers of the pleura

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9
Q

Visceral pleura

A

The thin serous membrane around the lungs and inner walls of the chest

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10
Q

What is a Simple PTX?

A
  • Non-expanding collection of air around the lung

- The lung is collapsed, to a variable extent.

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11
Q

Signs/symptoms of simple PTX

A
  • reduced air entry and resonance to percussion

- +/- subcutaneous emphysema and rib fractures

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12
Q

Tension PTX pathophysiology

A
  1. One way valve leak from lung or through chest wall
  2. ***Air forced into pleural space (clinical dx based on this)
  3. Eventual lung collapse
  4. Organ displacement
  5. Decreased venous return
  6. Reduction in cardiac output
  7. Obstructive shock
  8. Cardiac arrest
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13
Q

Tension PTX Signs/Symptoms

A
  • CP
  • Resp. distress (apprehension, agitation, cyanosis)
  • tachycardia
  • hypotension
  • **tracheal deviation AWAY from affected side
  • **u/l absent breath sounds
  • neck vein distention
  • shock (cool, clammy skin)
  • **hyperresonance to percussion
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14
Q

Indication for needle decompression

A

Tension PTX

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15
Q

Complications of needle decompression

A
  • Kinking of the catheter
  • Anatomical issues (large body habitus)
  • Can cause a subsequent PTX
  • Clot in catheter/local hematoma
  • Lung laceration
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16
Q

Systematic Approach to CXR

A

ABCDE&FGH

  • airway
  • bones
  • cardiac
  • diaphragm
  • equal (lung) fields
  • gastric bubble
  • hilum (and mediastinum)
17
Q

Needle decompression supplies

A
  • Luer Lock syringe

- 14g needle

18
Q

Needle Decompression Instructions

A
  1. High flow O2/ventilation
  2. 2nd ICS, midclavicular line
  3. Prep w/Betadine
  4. Local lidocaine
  5. Upright position if appropriate
  6. Keeping the Luer-Lock in the distal end of the catheter, insert an over the needle catheter 2 inches superior to the rib into the ICS
  7. Puncture the parietal pleura
  8. Remove Luer-Lock, listen for air
  9. **Prepare for chest tube insertion 5th ICS anterior to mid axillary line of affected side
  10. Connect the chest tube to an underwater-seal device or a flutter type valve apparatus and remove the catheter used to initially relieve the tension PTX
  11. Chest xray
19
Q

What is the next step in this patient’s care after needle decompression?

A

Chest tube

20
Q

Complications of chest injury

A
  • ARDS
  • Pulmonary contusion leading to ARDS & possible mechanical ventilation
  • Aortic injury
  • Bronchial tree injury
  • Pericardial effusion
21
Q

Chest tube Indications

A
  • Post Needle decompression
  • Hemothorax
  • Fluid
  • Pus (empyema)
  • Air
22
Q

Chest tube size for hemothorax

A

Large 30-40 French

23
Q

Chest tube size for PTX

A

Small 12-22 French or smaller 9-12 French pigtail catheters

24
Q

French chest tube equation

A

FR = D (mm) x 3

use external diameter

25
Q

Chest tube placement

A

-4th or 5th ICS in the mid to anterior axillary line

2nd ICS mid clavicular line can be used for PTX or if a second tube needs placed

26
Q

Absolute Contraindications for a chest tube

A

None!

27
Q

Relative Contraindications for a chest tube

A
  • coagulopathy

- prolonged prothrombin time or thrombocytopenia

28
Q

Chest tube placement instructions

A
  1. prep & drape
  2. local anesthesia
  3. 2-3cm transverse incision, bluntly dissect through subQ tissue over top of rib
  4. puncture the parietal pleura with tip of the clamp. Place gloved finger into the incision/hole to avoid injury to other organs and clear away any adhesions, clots
  5. Clamp end of tube and guide through dissected tunnel into pleural space. Guide it cephalad and posterior. Guide it until all the holes in the tube are within the pleural space
  6. watch for “fogging” with expiration or listen for air movement
  7. Connect the end of the tube to an underwater-seal apparatus . Recheck connection
  8. Suture tube in place using a purse string suture, wrapping the suture around the tube (SILK 1-0)
  9. Cover insertion site with Vaseline impregnated gauze
  10. CXR
  11. ABG’s & continuous pulse oximetry
29
Q

Chest tube complications

A
  • damage to nerve, vein or artery
  • converting a PTX to a hemopneumothorax
  • intercostal neuritis/neuralgia
  • tube kinking, clogging, falling out
  • persistent PTX
  • recurrence after tube removed
  • plugged bronchi, failed expansion
30
Q

How does the water seal chamber

A

Creates a one-way valve that prevents air or fluid from returning to the patient’s chest

31
Q

What do you want to monitor the water seal chamber for?

A
  • air leaks (bubbling)
  • tidaling (fluctuations in fluid level)
  • increased negative pressure

Med Procedures Quiz 2 (2 decks)

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