Week 2 - Chest Trauma and Thoracic INjuries

Question 1

what is a pneumothorax

Answer 1

• presence of air in the pleural space

Question 2

what does a pneumothorax result in

Answer 2

• complete or partial collapse of a lung cased by the accumulation of air in the pleural space

Question 3

when should a pneumothorax be suspected

Answer 3

• after any blunt trauma to the chest wall

Question 4

what are 3 types of pneumothorax

Answer 4

• open
• closed
• tension

Question 5

what is a closed pneumothorax

Answer 5

• a pneumothorax with no associated external wound

Question 6

what can cause a closed pneumothorax (2)

Answer 6

• spontaneous –> accumulation of air in the pleural space without an apparent antecedent event
• internal injury such as injury to the lungs from broken ribs

Question 7

what is an open pneumothorax

Answer 7

• occurs when air enters the pleural space thru an opening in the chest wall

Question 8

what can cause an open pneumothorax

Answer 8

• stab wound

- gunshot wound

Question 9

how should an open pneumothorax be treated

Answer 9

• should be covered w a vented dressing –> secured on 3 sides w the fourth side untaped

Question 10

why should an open pneumothorax be covered w a vented dressing

Answer 10

• allows air to escape from the vent on expiration, but not enter on inspiration
• decreases the likelihood of tension pneumothorax

Question 11

what is a tension pneumothorax

Answer 11

• a pneumothorax with rapid accumulation of air in the pleural space
• happens when the opening to the intrapleural space creates a 1-way valve –> air enters but cannot leave
• is an emergency

Question 12

what does a tension pneumothorax cause

Answer 12

• causes severely high intrapleural pressures –> mediastinum shift (to unaffected side)–> tension on the heart and great vessels & unaffected lung–> decreased venous return –> decreased CO & hypoexmia –> death

Question 13

what can cause a tension pneumothorax (4)

Answer 13

• both a closed or open pneumothorax
• mechanical ventilation
• resuscitative efforts
• clamped chest tubes

Question 14

what effect does a tension pneumothorax have on CO

Answer 14

• decreased CO

- P on vena cava = cannot drain blood to heart = heart has nothing to pump

Question 15

why is a tension pneumothorax a medical emergency

Answer 15

• effects both the resp and circulatory systems

Question 16

what is a hemothorax

Answer 16

• accumulation of blood in the pleural space

Question 17

what can cause a hemothorax (5)

Answer 17

• chest trauma
• lung malignancy
• complications of anticoag
• pulmonary embolus
• tearing of pleural adhesions

Question 18

what are symptoms of a small pneumothorax (2)

Answer 18

• mild tachy

- dyspnea

Question 19

what are symptoms of a large pneumothorax (8)

Answer 19

• resp distress
• shallow, rapid respirations
• dyspnea
• air hunger
• decreased O2 sat
• chest pain
• cough w or w/o hemoptysis
• no breath sounds in affected area

Question 20

what are symptoms of a tension pneumothorax (7)

Answer 20

• symptoms of pneumothorax +
• severe resp distress
• tachy
• hypotension
• mediastinal displacement
• trachea shift to unaffected side
• hemodynamically unstable

Question 21

what is seen on a chest xray for pneumothorax

Answer 21

• presence of air or fluid in pleural space

Question 22

treatment of a pneumothroax depends on

Answer 22

• severity

- nature of underlying disease

Question 23

if it is a small pneumothorax, and the pt is stable & the amt of air/fluid in the pleural space is minimal, what treatment

Answer 23

• no treatment
• may resolve spontaneously
  (small amts can be reabsorbed over time)

Question 24

if the amt of air or fluid is minimal, how can a pneumothorax be treated

Answer 24

• the pleural space can be aspirated w a large bore needle

Question 25

what is the most definitive and common form of treatment for a pneumothorax

Answer 25

• insertion of a chest tube & connect it to a waster-seal drainage

Question 26

what is the purpose of chest tubes & pleural drainage

Answer 26

• remove air & fluid from the pleural space & restore normal intrapleural pressure so the lungs can re-expand

Question 27

what is important to monitor r/t chest tubes & drainage (3)

Answer 27

• make sure lines aren’t kinked & secure
• keep below lvl of chest
• assess for air leaks

Question 28

what are nursing interventions for a pt with pneumothorax (5)

Answer 28

• monitor breath sounds
• rise and fall of chest
• VS (HR, BP, RR, O2)
• patient effort of breathing
• keep HOB elevated

Question 29

what is flail chest

Answer 29

• instability of the chest wall caused by multiple rib fractures

Question 30

what happens when the pt breaths during flail chest

Answer 30

• the affected (flail) area will move paradoxically to the
  unaffected area
• inspiration: gets sucked in
• expiration: bulges out

Question 31

what does the paradoxical chest movement cause (2)

Answer 31

• prevents adequate ventilation

- hypoxemia

Question 32

what are symptoms of flail chest (4)

Answer 32

• paradoxical mvmt
• rapid, shallow resp
• tachy
• movement of thorax is asymmetrical

Question 33

what diagnostics are used to assess flail chest (5)

Answer 33

• visual exam
• palpation of abnormal resp movements
• crepitus of ribs
• chest xray
• ABGs

Question 34

what is the treatment for flail chest (8)

Answer 34

• O2 therapy
• pain control
• crystalloid IV therapy
• intubation
• ventilation
• chest tubes
• ribs heal on own in time
• rest & time

Question 35

what is the definitive therapy for flail chest

Answer 35

-re-expand the lung & ensure adequate oxygenation