Lower Respiratory Problems

Question 1

Chest strikes or is struck by an object. May appear minor, but can have major internal injury. Impact causes deceleration, acceleration, shearing, compression of thoracic features.

Answer 1

Blunt chest trauma

Question 2

Open injury in which a foreign body impales or passes through the body tissues.

Answer 2

Penetrating chest trauma

Question 3

Air in the pleural space causing a partial or complete collapse of the lung (increasing intrathoracic pressure and decreasing lung capacity).
C/b an injury to the chest wall or a hole in the lung. Causes complete or partial lung collapse (should be suspected in ANY blunt trauma to chest wall).
Air is coming in 2 ways: down the trachea, through the hole in the chest cavity. The surface tension between the lung and the chest is interrupted

Answer 3

Pneomothorax

Question 4

If small, may only have mild tachycardia and dyspnea. If large, will have resp. distress. Shallow, rapid resps, dyspnea, air hunger, O2 hunger, disats.
Chest pain w/ or w/o cough, hemoptysis. No breath sounds over the affected area.
CXR: air/fluid in the pleural space/reduction in LV.
If tracheal deviation, EMERGENCY.
Tx: if stable and small, no tx or thoracentesis. Chest tube to water-seal drainage. If recurrent, pleurectomy or pleurodesis.

Answer 4

Pneomothorax

Question 5

Air enters, but doesn’t leave, the pleural space. Increased intracellular pressure builds up so much that it stops the return of blood to the heart (tracheal deviation, mediastinal shift). The mediastinum shifts towards the unaffected side, compressing the good lung. Venous return decreases, cardiac output falls. May result from open/closed pneumothorax. Open wound flap may act as one way valve. Air can enter on inspiration but cannot escape. Clamped chest tubes/mechanical vent

Answer 5

Tension pneumothorax

Question 6

S/S: Dyspnea, marked tachycardia, tracheal deviation, decreased/absent breath sounds of the affected side, neck vein distention, cyanosis, diaphoresis

Answer 6

Tension Pneumothorax

Question 7

Tx: Open- cover wound with vented dressing (open on 3 sides, 4th side untaped). DO NOT remove the object, stabilize with a bulky dressing. Needle decompression/CT

Answer 7

Tension pneumothorax

Question 8

No external wound, most common from spontaneous pneumothorax, with no apparent antecedent event

Answer 8

Closed pneumothorax

Question 9

Opening in the chest wall, stab, gunshot, surgery. “Sucking chest wound” from penetrating chest wound. Cover with vented dressing. DO NOT REMOVE THE OBJECT!

Answer 9

Open pneumothorax

Question 10

Blood in intracellular space. C/b chest trauma, lung malignancy, cx of anticoag therapy, pulmonary embolus or tearing of pleural adhesions. Chest tube/water seal drainage.

Answer 10

Hemothorax

Question 11

Lymphatic leak into intracellular space d/t leak in thoracic duct.

Answer 11

Chylothorax

Question 12

Occurs when there is a fracture of 2 or more ribs in 2 or more locations causing an unstable segment. Chest wall can’t provide enough support to allow ventilation.
S/S: Paradoxic chest movement- inward movement of thorax during inspiration with outward movement during expiration. Tachycardia. Bruised chest. Dyspnea. Pain. Easy to see in unconscious pt.
Tx: oxygen, pain control, monitor ABGs, may need intubation

Answer 12

flail chest

Question 13

Drain placed in the pleural space, collection container below chest level, water seal (keeps air from entering the chest), 6 feet of tubing, drainage system.
Tube is placed depending on whether the problem is with air or blood accumulation.
Flutter or Heimlich valve is a one way valve with a rigid plastic tube that opens with expiration, allows for mobility, pt can go home with it.
Insertion- have pt Valsalva (exhale); don’t let them talk or cough, help them stay still, keep them calm

Answer 13

Chest tubes

Question 14

Drainage system chambers

Answer 14

Tube from the pt is connected to the first chamber (collection chamber: gets fluid or air from the chest. mark the measurements)
2nd chamber is the water seal to prevent air from going back to the pt. 2 cm H20 and acts as a one-way valve, will have lots of bubbling at first if the pt has a large pneumo, after that will see bubbling with exhalation, coughing, sneezing; if excessive bubbling could indicate an air leak.
3rd chamber is where suction is applied (suction regulator). Can be water or dry.If water will have 20 cm column of water, suction source will cause if to bubble

Question 15

Chest tubes

Answer 15

Must remain a closed system of negative pressure pulls air into the space and causes a pneumothorax.

Question 16

Will need routine pain meds. Do not clamp for more than a few minutes. If it becomes disconnected, immerse in sterile water until system is reestablished. Sterile technique with all dressing changes.
Removal- give pain meds 15 min before. Have pt valsalva or exhale and bear down. Immediately cover site with petroleum jelly dressing. Obtain CXR.
Always keep a sterile dressing over the site, hourly checks of sterility, patency of tube; after 24 hrs can check q8.
Call if drainage >100mL in 1 hr.
Watch water seal chamber for unexpected bubbling.
Accidental removal- need to cover the site with petroleum jelly dressing

Answer 16

Chest tubes