MED/SURG: TRAUMA: BREATHING Flashcards
Breathing: Assess 2 things? BASIC
- Respiratory Rate
* Lung Sounds
Breathing: Medical Interventions (4)
Breathing: Medical Interventions1.Oxygen2.NRB3.Ambu bag4.Intubate and ventilate
Breathing: Lung Sounds can change based on the type of chest trauma
Yup!
Lung Sounds can change based on the type of CHEST TRAUMA
YUP!
FLAIL CHEST
- S/S
- TX
A flail chest is identified as paradoxical movement of a segment of the chest wall - ie indrawing on inspiration and moving outwards on expiration. This is often better appreciated by palpation than by inspection.The main significance of a flail chest however is that it indicates the presence of an underlyingpulmonary contusion.This strategy is aimed at preventing the development of pneumonia, which is the most common complication of chest wall injury. Note that while a young fit patient will easily manage one or two rib fractures with simple analgesia, the same injury in an elderly patient is regarded as major and will frequently lead to pneumonia and respiratory failure if not appropriately managed (and even then).All patients should initially be placed on 100% oxygen via a non-rebreathing facemask.
Tension pneumothorax
- What is it?
- Classic Sign?
- TX? (2)
Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return. Positive pressure ventilation may exacerbate this ‘one-way-valve’ effect. This leads to circulatory instability and may result in traumatic arrest. The classic signs of a tension pneumothorax are deviation of the trachea away from the side with the tension, a hyper-expanded chest, an increased percussion note and a hyper-expanded chest
* Needle Thoracostomy and chest tubes
Tension pneumothorax
- Skin intact?
- Internal or external trauma?
- Chest tube placement?
- Yes
- Internal
- High chest tube placement
Haemothorax
- What is it?
- Classic Sign
- Dx
- TX (2
- Haemothorax is a collection of blood in the pleural space and may be caused by blunt or penetrating trauma. Most haemothoraces are the result of rib fractures, The classic signs of a haemothorax are decreased chest expansion, dullness to percussion and reduced breath sounds in the affected hemithorax.
- dx: CT scan
- Chest tube low andThoracotomy
Pneumothorax - OpenSucking Chest Wound
- What is it?
- TX (4)Dressing do not block dressing should be a FLAP
During inspiration, when a negative intra-thoracic pressure is generated, air is entrained into the chest cavity not through the trachea but through the hole in the chest wall. This is because the chest wall defect is much shorter than the trachea, and hence provides less resistance to flow. Once the size of the hole is more than 0.75 times the size of the trachea, air preferentially enters through the thoracic cavity. This results in inadequate oxygenation and ventilation, and a progressive build-up of air in the pleural space. The pneumothorax may tension if a flap has been created that allows air in, but not out. 100% oxygen should be delivered via a facemask. Consideration should be given to intubation where oxygenation or ventilation is inadequate. Intubation should not delay placement of a chest tube and closure of the wound. The definitive management of the open pneumothorax is to place an occlusive dressing over the wound and immediately place anintercostal chest drain
*
Cardiac Tamponade
In this condition, blood or fluid collects in the pericardium, the sac surrounding the heart. This prevents the heart ventricles from expanding fully. The excess pressure from the fluid prevents the heart from working properly. As a result, the body does not get enough blood.
Cardiac Tamponade
* S/S
Anxiety, restlessnessSharpchest painthat is felt in the neck, shoulder, back, or abdomenChest pain that gets worse with deep breathing or coughingProblems breathingDiscomfort, sometimes relieved by sitting upright or leaning forwardFainting, light-headednessPale, gray, or blue skinPalpitationsRapid breathingSwelling of the abdomen or other areas
Cardiac Tamponade
* TX (6)
Pericardiocentesisis a procedure that uses a needle to remove fluid from the tissue that surrounds the heart (pericardial sac).A surgical procedure to cut and remove part of the pericardium may also be done. This is known as surgical pericardiectomy or pericardial window.Fluids are given to keep blood pressure normal until the fluid can be drained from around the heart. Medicines that increase blood pressure may also help keep the person alive until the fluid is drained.Oxygen may be given to help reduce the workload on the heart by decreasing tissue demands for blood flow.The cause of tamponade must be found and treated.
