Respiratory 6 Flashcards
describe tension pneumothorax
**nothing open to the outside, all inside pressure
Penetrating chest wound treated with an airtight dressing
Fractured ribs
Mechanical ventilation
High level PEEP
Chest tube occlusion or malfunction
describe traumatic pneumothorax
Chest injury, stab or gunshot wound Insertion of central line Chest surgery Thoracentesis Blunt chest trauma Ruptured blebs, who has these? Barotrauma
signs of pneumothorax
- Sharp sudden, pleuritic chest pain, breathing exacerbates the pain
- Asymmetric chest wall movement, cool, clammy and diaphoretic, subcutaneous emphysema
signs of tension pneumothorax
- Hypotension, tachycardia
- Tracheal deviation to the opposite side
- Distended neck veins
- Medianstinal shift
why is tension pneumothorax so severe
- will cause pressure to go to other side/lung and collapse other side as well**
- pt will die unless chest tubes are put in
- nurse MUST call someone, nothing they can do in this situation
pneumothorax treatment
- Greater than 30% lung collapse, needs a chest tube in the second or third IC space in midclavicular line to reexpand the lung
- This restores negative intrapleural pressure
tension pneumothorax treatment
- immediate large-bore needle insertion into the pleural space through the second IC space
- Make sure the CT is patent
- Monitor for further distress, watch for worsening SQ emphysema of the face and neck
what is a pulmonary emboli
Obstruction of the pulmonary circulation
Perfusion problem: Oxygen cannot get into blood supply
causes of pulmonary emboli
- Dislodged thrombus from legs, pelvis, renal or hepatic veins
- Can also be fat, air, tumor or foreign object
- Fat emboli can be from osteomyelitis, long bone fractures and adipose tissue
- Air emboli from dialysis, bypass machine, catheter insertion and endoscopy
signs of PE if <50% of vessel occluded
may have shortness of breath, anxiety, chest pain, extra heart sound and crackles
signs of PE if >50% of vessel occluded
sense of impending doom, dyspnea, tachycardia, confusion, right sided failure, hypotension and PEA
risk factors of PE
Lung disorders, valve disease and arrhythmias, diabetes, VTE, sickle cell disease
Venous stasis, obese,
burns, casts
Venous injury from surgery, long bone or pelvic fractures, discontinued CVC
Cancer, hormone therapy, smoking, pregnancy and edema
things to remember about PE
Will die if it is large
Blue from that area on up
Chest pain and cannot breathe (code situation)
Survival is low if large
Watch for pt with pneumonia, may develop this
when will a fat emboli have s/s
may take as long as 24 hrs
when will air emboli have s/s
immediately!!!
palpitations, weakness and tachycardia
