Unit 3 Chest tubes/Pneumothorax/Hemothorax Flashcards
What can be assessed in Rib contusion or fracture? How is it diagnosed?
Hemoptysis Decreased BS Crackles/Wheezes Pain with movement Splinting
Dx via CXR, CT scan
What is the collaborative care for rib contusions and fractures/chest trauma?
Supplemental O2 Incentive spirometry C and DB Activity Pain management Pillow splint
What is a Pneumothorax and what are the types?
Thoracic injury that allows accumulation of atmospheric air into pleural space; lung collapses.
Types:
Open (ex: penetrating wound)
Closed (ex: contusion damage, spontaneous)
Tension - air trapped into pleural space with each inspiration with no release during expiration, leads to complete collapse of lung
What are the manifestations of a Pneumothorax?
Abnormal chest wall movement Hyper-resonance (high-pitched sound) Trachea deviation Chest pain Tachypnea Subcutaneous emphysema (air entering skin of chest wall)
What is the definite Dx for a Pneumothorax of any kind?
CXR (chest x-ray)
Which is more likely to lead to a tension pneumothorax open or closed?
Open because with each inhalation air will continually keep getting trapped.
What are the 3 parts to a chest tube drainage system? describe.
Suction control chamber (should have gentle suctioning, distilled water, usually 15-20)
Water seal chamber
(acts as one-way valve to let air escape, 2cm marker.)
Collection chamber
> 100 mL/hr should be notified
What is the intervention for a Pneumothorax?
Chest tube! Allows for air to escape and lung segment to reinflate (placed high)
What are other things that could cause a Pneumothorax?
Blunt chest trauma
Chest tubes
Mechanical ventilation (barotrauma)
Insertion of central venous catheter
What are signs and symptoms of a tension Pneumothorax?
Asymmetry of thorax Respiratory distress Unilateral absence of BS Distended neck veins Cyanosis
THIS IS AN EMERGENCY
What is the intervention for a tension Pneumothorax? Hemothorax?
Chest tube
Large bore needle
In second intercostal space (placed high for Pneumothorax).
Chest tube between 5th and 6th intercostal space towards the side/back
What is the interventions for a Hemothorax?
Chest tube placed LOW, between the 5th and 6th intercostal space, usually on the side.
What is a Hemothorax?
Loss of blood into thoracic cavity
Usually caused by trauma or sx
What are the manifestations of a Hemothorax? How is it confirmed?
- If small amount, may be asymptomatic
- Respiratory distress
- Decreased BS
- Dull to percussion
- Hgb and Hct might also be abnormal
-Confirmed by CXR and thoracentesis
What is the collaborative management of a Hemothorax?
Evacuate blood
Normalize pulmonary function
Replace fluids
CHEST TUBE
Regarding a Hemothorax, what amount of blood loss indicates an issue?
If initial blood loss is 1500-2000 ml or if there is bleeding of 200mL/hr over 3 hrs than PT may require Sx.
What is Flail Chest?
Occurs with multiple fractured ribs (typically 3 in a row)
Paradoxical respirations. One of the most critical chest injuries.
Part of rib-cage is separated from rest of the chest and begins to move.
What are the purposes of chest tubes?
Pneumothorax Hemothorax Pleural effusion Lung abscess (infection) Chest trauma
What is a Heimlich valve?
One way valve to let air escape - dry suction
What might be indicated if there are no fluctuations in the water-seal chamber? What about continuous bubbling?
Kink or lung has re-expanded.
Air-leak
What should you never do regarding fluid in the tubes?
NEVER MILK IT
What should normally be happening with the water seal chamber and the suction control chamber?
Water seal chamber:
- should slightly rise and fall with respirations
- *inverse when on MV**
Suction control chamber:
-should have gentle continuous bubbling
