Week 2 - Chest Trauma and Thoracic INjuries Flashcards
what is a pneumothorax
- presence of air in the pleural space
what does a pneumothorax result in
- complete or partial collapse of a lung cased by the accumulation of air in the pleural space
when should a pneumothorax be suspected
- after any blunt trauma to the chest wall
what are 3 types of pneumothorax
- open
- closed
- tension
what is a closed pneumothorax
- a pneumothorax with no associated external wound
what can cause a closed pneumothorax (2)
- spontaneous –> accumulation of air in the pleural space without an apparent antecedent event
- internal injury such as injury to the lungs from broken ribs
what is an open pneumothorax
- occurs when air enters the pleural space thru an opening in the chest wall
what can cause an open pneumothorax
- stab wound
- gunshot wound
how should an open pneumothorax be treated
- should be covered w a vented dressing –> secured on 3 sides w the fourth side untaped
why should an open pneumothorax be covered w a vented dressing
- allows air to escape from the vent on expiration, but not enter on inspiration
- decreases the likelihood of tension pneumothorax
what is a tension pneumothorax
- 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
what does a tension pneumothorax cause
- 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
what can cause a tension pneumothorax (4)
- both a closed or open pneumothorax
- mechanical ventilation
- resuscitative efforts
- clamped chest tubes
what effect does a tension pneumothorax have on CO
- decreased CO
- P on vena cava = cannot drain blood to heart = heart has nothing to pump
why is a tension pneumothorax a medical emergency
- effects both the resp and circulatory systems
what is a hemothorax
- accumulation of blood in the pleural space
what can cause a hemothorax (5)
- chest trauma
- lung malignancy
- complications of anticoag
- pulmonary embolus
- tearing of pleural adhesions
what are symptoms of a small pneumothorax (2)
- mild tachy
- dyspnea
what are symptoms of a large pneumothorax (8)
- 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
what are symptoms of a tension pneumothorax (7)
- symptoms of pneumothorax +
- severe resp distress
- tachy
- hypotension
- mediastinal displacement
- trachea shift to unaffected side
- hemodynamically unstable
what is seen on a chest xray for pneumothorax
- presence of air or fluid in pleural space
treatment of a pneumothroax depends on
- severity
- nature of underlying disease
if it is a small pneumothorax, and the pt is stable & the amt of air/fluid in the pleural space is minimal, what treatment
- no treatment
- may resolve spontaneously
(small amts can be reabsorbed over time)
if the amt of air or fluid is minimal, how can a pneumothorax be treated
- the pleural space can be aspirated w a large bore needle
what is the most definitive and common form of treatment for a pneumothorax
- insertion of a chest tube & connect it to a waster-seal drainage
what is the purpose of chest tubes & pleural drainage
- remove air & fluid from the pleural space & restore normal intrapleural pressure so the lungs can re-expand
what is important to monitor r/t chest tubes & drainage (3)
- make sure lines aren’t kinked & secure
- keep below lvl of chest
- assess for air leaks
what are nursing interventions for a pt with pneumothorax (5)
- monitor breath sounds
- rise and fall of chest
- VS (HR, BP, RR, O2)
- patient effort of breathing
- keep HOB elevated
what is flail chest
- instability of the chest wall caused by multiple rib fractures
what happens when the pt breaths during flail chest
- the affected (flail) area will move paradoxically to the
unaffected area - inspiration: gets sucked in
- expiration: bulges out
what does the paradoxical chest movement cause (2)
- prevents adequate ventilation
- hypoxemia
what are symptoms of flail chest (4)
- paradoxical mvmt
- rapid, shallow resp
- tachy
- movement of thorax is asymmetrical
what diagnostics are used to assess flail chest (5)
- visual exam
- palpation of abnormal resp movements
- crepitus of ribs
- chest xray
- ABGs
what is the treatment for flail chest (8)
- O2 therapy
- pain control
- crystalloid IV therapy
- intubation
- ventilation
- chest tubes
- ribs heal on own in time
- rest & time
what is the definitive therapy for flail chest
-re-expand the lung & ensure adequate oxygenation
