Thoracic Trauma Flashcards
If a patient with Thoracic trauma has agitation, one should assume…
that pt has an airway, breathing, and/or perfusion problem.
Abnormal distension of neck veins in chest trauma may indicate…
tension pneumothorax or cardiac tamponade
Tension pneumothorax
Most common from blunt trauma. A closed pneumothorax progressively accumulates air within the pleural space on inspiration and produces and increase in intrapleural tension collapsing the lung on the affected side, depressing the diaphragm and shifting the mediastinum to the opposite side also compromising the intact lung and causing tracheal deviation
How does Tension pneumothorax compromise heart?
High intrathoracic pressures exceed CVP pressures and compress the right atrium and vena cavae creating a mechanical obstruction of blood flow to the right heart resulting in markedly decreased preload and cardiac output. Hemodynamic dysfunction produces hypoxia and obstructive shock
Tension pneumothorax assessment findings
Inspect for Severe pleuritic CP, restlessness, agitation, dyspnea, tachypnea, retrations, asymmetric chest movement, JVD, cyanosis. Palpate for sub q emphysema. Percuss for hyperresonance on affected side. Auscultate for absent or decreased breath sounds on affected side, distant heart sound (r/t shift)
What should be performed immediately in suspected tension pneumothorax
Needle thoracentesis to 2nd-3rd midclavicular line. CDC recommends cleansing with chlorhexidine first. This should relieve acute distress and improve ventilations but will no re-expand the lung/ Prepare for chest tube insertion
Water seal
U-tube design that acts as a one-way valve that prevents air from reentering the chest with inspiration. It can monitor air leaks and changes in intrathoracic pressure.
Suction control chamber
contain an atmospheric vent. The suction chamber helps monitor intrathoracic pressure. Dry-suction and water-suction units are set to the prescribed amount of suction either by rotating a dial to the prescribed amount, or in the case of water-suction, are filled with sterile water to the prescribed level.
What should be immediately reported to the physician regarding chest tubes.
Absence of fluid oscillation, continuous bubbling, sub-q emphysema in the neck and upper chest or near the tube insertion site.
What could happen if you clamp a chest tube with an continuing air leak
may result in a tension pneumothorax
What intervention should be performed when a sucking chest wound is found?
Convert to a closed pneumothorax by covering wound with a gloved hand and then an occlusive dressing at the end of the expiration. Dressings should be at least 3-4 times the size of the defect.
Why should positive pressure ventilations be used with caution in penetrating chest wounds?
High ventilator pressure may force air from an injured bronchus into an adjacent open pulmonary vein, producing a systemic air emboli.
Flail chest
occurs when two or more adjacent ribs and/or cartilages on both sides of an impact point are broken at two points resulting in a freely mobile or “floating” segment
What is the most significant life-threat with flail chest?
the damage from the lung parenchyma: pulmonary contusion. Contused lung produces more interstitial and intra-alveolar fluid resulting in impaired gas exchange.
