Penetrating Chest Trauma Flashcards
What is the pathophysiology of Hemothorax/Pneumotherax ?
Blood or air has accumulated in the pleural space
What has happened to the lung in Hemotherax/Pneumotherax ?
It has collapsed
What are signs & symptoms of Hemothorax/Pneumothorax ?
- SOB
- Increased HR
- Diminished breath sounds on the affected side
- Less movement on the affected side
- Chest pain
- Cough
What will show up on the X-ray in a client with either a Hemothorax/Pneumothorax ?
Hemothorax = Blood (Hem) Pneumothorax = Air (pneumo)
What is Subcutaneos emphysema ?
Air trapped in the tissue (usually neck, face, and chest)
- feels like rice crispies (crepitus)
What is the Tx for Hemotherax/Pneumothorax ?
- Thoracentesis
- Chest tube
- Daily chest x-ray
What is the Pathophysiology of Tension Pneumothorax ?
Pressure has built up in the chest/pleural space and has collapsed the lung
(pressure pushes everything to the opposite side - medicinal shift)
What does Tension Pneumothorax cause ?
Mediastinal shift
If the trachea is deviated due to mediastinal shift, what is it ?
An Emergency!
What are the causes of Tension Pneumothorax ?
- Trauma
- Too much PEEP (ventilator settings)
- Clamping a chest tube
- Inserting central venous lines
- Taping an open pneumothorax on all 4 sides without an air valve
What are signs and symptoms of a Tension Pneumothorax ?
- Subcutaneous emphysema
- Absence of breath sounds on one side
- Asymmetry of thorax
- Respiratory distress
- Cyanosis
- Distended neck veins, or JVD
Tension pneumothorax can be what ? and why ?
Fatal
as accumulating pressure compresses vessels –> decreases venous return –> decreases cardiac output
What is the Tx for Tension Pneumothorax ?
- Large bore needle is placed into the 2nd intercostal space (by the PCP) to allow excess air to escape
- Treat the cause (chest tubes will be inserted)
Open pneumothorax is also known as what ?
Sucking chest wound
What is the Pathophysiology of an Open Pneumothorax (sucking chest wound) ?
Opening through the chest that allows air into the pleural space
What is the Treatment for Open Pneumothorax (sucking chest wound) ?
- Have the client inhale and hold or Valsalva or hummmmm
- Then, place the a piece of petroleum gauze over the area
- Have the client sit up (if possible) to expand lungs
(trauma clients stay flat, until evaluated for other injuries)
In clients with an Open pneumothorax, why do you want them to inhale and hold or valsalva or hummmmm ?
These will increase the intra-thoracic pressure so no more outside air can get into the body
In a client with an Open pneumothorax, how many sides should you tape down & why when placing a piece of petroleum gauze over the area ?
3 sides
Because the fourth side acts like an air vent or flutter valve
