Pressure Injuries Flashcards
Who identified DCS and in what year?
Paul Bert 1878
DCS - decompression sickness
Bubbles in the tissues or vessels caused by a reduction in pressure
S/Sx of DCS
Malaise, anorexia, fatigue out of line of preceding activity. If no other Sx, consider it a warning.
Sx of skin bends
Itching after exposure to compressed air environment, not after immersion.
Sx of cutis marmorata
Blotchy red or purple rash, usually over the upper trunk, blanches under direct pressure.
Lymphatic DCS Sx
Thought to be caused by blockage of the lymphatics and glands. “Peau d’orange” caused by edema, usually seen in the limbs, parotid, or mammary regions.
The “bends” Sx
Most widely occurring form of DCS. Common sites are knees and shoulders. Pain can be mild to severe. Bubbles have formed in the tissues/joints causing pain.
Neurological DCS Sx
Any neurological Sx or deficit after exposure to higher pressure: loss of consciousness, “plegias”, vertigo, deafness, tingling, diminished vibratory sense, loss of anal sphincter tone.
Sx of the “chokes”
Retrosternal pain which limits deep inspiration, dry cough, shallow/rapid inspirations, theorized to be due to venous gas emboli
3 types of DCS
Type 1 - constitutional, skin, pain only
Type 2 - serious neurological sx (Vestibular, sensory, spinal cord, brain)
Type 3 - DCS associated with AGE or VGE (cardiopulmonary Sx - retrosternal pain; dry cough; shallow, rapid respirations - the chokes)
Treatment table for type 1 DCS
Treatment table 5
Treatment for type 2 or 3 DCS
Treatment table 6
AGE
Symptomatic bubbles in the circulatory system or vessels.
Causes of AGE
Caused by pulmonary barotrauma during free ascent after breathing compressed air at depth. (Alveolar tear introduces air into pulmonary capillaries. Air is transported by circulation to the brain.)
Also can be caused by lung pathology, penetrating chest trauma.
Iatrogenic (nosocomial) methods of AGE formation
Heart/lung machines, cardiac cath, mechanical ventilation, chest tube placement, bronchoscopy, IV air injection, hemodialysis, central venous catheter placement.
S/Sx of AGE
Depends on where the bubbles land.
Arterial bubbles that end up in cerebral circulation (CAGE) manifest like a stroke, loss of consciousness, confusion, vertigo, visual deficit, etc. Can end up elsewhere: cardiac arrest.
VGE s/Sx
Form same as AGE, but end up in venous system and usually removed without complication.
Massive amounts of bubbles in venous system = chokes.
How do VGE get into arterial system?
Patent foramen ovals - opening in the wall between the right atrium (de-oxygenated side) and the left atrium (oxygenated side)
Treatment for AGE/VGE
Treatment table 6
Pneumothorax - what is it and what causes it
Hole in the lung that allows air to go where it doesn’t belong.
Caused by pulmonary over pressure (Holding breath during ascent-Boyle’s law)
Also caused by trauma, central line insertion or removal.
May occur spontaneously.
Sx- pain in chest, difficulty breathing, increased heart rate, increased ventilator peak pressure if intubated
Tension pneumothorax - what is it, s/sx
Enough pressure between the pleura and the lung tissue to cause the lung to collapse - a worse pneumo
Will cause trachea and heart to shift away from the collapsed side. Will cause circulatory blockage to the heart.
No breath sounds on affected side
Treatment for pneumothorax
Chest tube or large bore needle insertion. This allows collapsed lung to reinflate and venous return to the heart to be unimpeded.
HBO and pneumo
Any pt with chest trauma requires X-ray to confirm no pneumo or resolution of an existing pneumo prior to HBO
Chest tube pts must have Heimlich valve attached.
Any opening in chest needs covered with occlusive dressing - recently removed triple or double lumen IV, recently removed chest tube
Pneumomediastinum
Air trapped behind the mediastinum. Comes from ruptured lung.
May be seen with subcutaneous emphysema - air trapped beneath the skin. Normally seen in the upper chest and neck. May cause pressure on the lungs, trachea, heart, great vessels, esophagus, vocal cords. Crepitus.
Treatment for pnuemomediastinum and subcutaneous emphysema
100% oxygen at 1 ATA
Most common barotrauma in HBO and scuba diving
Middle ear barotrauma
Caused by compressing the vol of gas in the middle ear (Boyle’s law)
Ways to open Eustachian tubes
Valsalva, Toynbee, swallowing, or by creating an opening in the tympanic membrane. (Rupture, myringotomy, PE tubes)
Patients most likely to have trouble equalizing
Anatomical abnormalities, cleft palate, upper respiratory infection, sinusitis, viral infections, otitis media, allergic rhinitis, radiation.
Pts not conscious or sedated will not be able to clear ears
How to help pts with trouble clearing
Teaching, chamber manipulation, pre treat with decongestants, send to ENT for tx or tubes.
What is reverse ear squeeze
Caused Eustachian tube dysfunction at end of tx. Can cause alternobaric vertigo.
What can happen if a pt performs Valsalva maneuvers too vigorously?
Rupture of the round or oval window, which opens a channel between the inner and middle ear, potentially disturbing auditory function and balance.
Sinus pain and HBOT
Blocked sinuses can cause pain on compression. Can be mistaken for tooth pain or barotrauma in upper teeth.
Pretreat with decongestants, nasal steroids.
Hold tx until Sx resolve
GI pain prevention
Avoid gas-causing foods, avoid carbonated beverages, admin gas reducing meds, move around, sit up
What is barodontalgia
Caused when small amount of trapped gas in a tooth expands on ascent, causing pain.
Happens in teeth with loose or new filings, or recent root canal.
No treatment. Send to dentist
Ocular trauma
Occurs when air space in diving masks compresses during descent.
Causes damage to eye lids (edema, swelling, bruising) or conjunctival bleeding.
Potential for hard contact lenses to ocular barotrauma in chamber.
