453: Test 1 Chest Trauma and Thoracic Injuries

Frage	Antworten
Two major categories of chest trauma/thoracic injuries	Blunt: Body is stuck by a blunt object Penetrating Trauma: Foreign body impales or passes through body tissues. Open injury.
What is the primary management of a chest trauma/thoracic injury	Airway
In blunt force trauma what is acceleration/deceleration?	Example: car decelerates after hitting object but organs accelerate
Other factors to consider with blunt force traumas	shearing force (tissue riding over and ripping) crush/asphyxiation organ/lung damage underneath
S/S of Asphyxiation (crush)	Petechiae in the whites of the eyes, cheeks, face. Look at marking on the front and back of the patient. Crushing pressure can become systemic not just localized to injury
Examples of penetrating trauma	GSW (gun shot wound) stabbing impalement
___________ is when there is air in the pleural space resulting in partial collapse of the lung.	Pneumothorax
With a pneumothorax the pressure in the lung goes from a ________ pressure to a ________ pressure	Negative Pressure → Positive Pressure
Clinical manifestations of a pneumothorax depend on size but include:	Respiratory Distress (shallow, rapid resps; dyspnea; air hunger; O2 desaturation) Chest pain cough ABSENT BREATH SOUNDS
the presence of lymphatic fluid in the pleural space due to a leak in the thoracic duct	Chylothorax
Blood in the pleural space, may or may not occur in conjunction with pneumothorax.	Hemothorax
The increased air in the pleural space shifts organs and increases intrathoracic pressure	Tension pneumothorax
How to treat a traumatic open (sucking) pneumothorax	1. Ensure patent airway and administer 02 2.Get IV access and start fluids 3. Cover sucking chest wound with occlusive vented dressing taped on 3 sides Stabilize impaled objects. Don't remove. 4. Stabilize flail rib segment 5.If no spinal injury place pt in a semi-Fowler's position or what is easiest to breath.
This type of pneumothorax can occur due to laceration or puncture of the lung during medical procedures. Transthoracic needle aspiration is the leading cause	Iatrogenic pneumothorax
A _____________ pneumothorax typically occurs due to the rupture of small blebs (air-filled blisters) located on the apex of the lung.	spontaneous
Spontaneous pneumothorax is the rupture of Blebs or _______ in COPD, Asthma, Cystic Fibrosis, and Pneumonia patients.	Bullae (air or pus filled in PLEURAL SPACE)
Another name for spontaneous pneumothorax	closed pneumothorax
Why is it important to allow air to escape for a open pneumothorax?	Prevent tension pneumothorax, acts as a one way valve
The rapid accumulation of air in the pleural space without the ability to escape is a pneumothorax. What are early signs of this?	MOSTLY: SOB and TACHYCARDIA Also: dyspnea, O2 deceleration, decreased or absent breath sounds, diaphoresis
The rapid accumulation of air in the pleural space without the ability to escape is a pneumothorax. What are late signs of this?	NVD/JVD, cyanosis Unilateral movement of the chest and tracheal deviation
____________ is when air escapes in the pleural space and goes into the SQ space. Crackles felt upon palpation. Signs of a pneumothorax.	Subcutaneous Emphysema
How much blood loss from a auto transfusion or chest tube is to much?	about a unit =16oz =450 mL
Causes of hemothorax include	Open Pneumothorax Trauma Malignancy Anticoagulant Therapy pulmonary embolus torn pleural adhesions
Causes of chylothorax include trauma, surgical procedures and malignancy. Therapy includes:	Conservative therapy: chest drainage bowel rest (increases tenfold after digestion of fats) parenteral nutrition Invasive therapy: surgery and pleurodesis (artificial production of adhesions between the parietal and visceral pleura)
Treatment of pneumothorax depends on severity. Collaborative care includes:	Preserve Hemodynamic stability CXR ABGs Chest-tube Heimlich/flutter valve: valve opens whenever the pressure in the chest is greater than atmospheric pressure. Ex. expiration needle venting
When a chest tube is set to water seal is it ok if there is persistent bubbling of air through the water?	No. Can bubble slightly with inspiration. Persistent bubbling indicates an air leak in the lung. Bubbling in the first 24 hours is more normal.
What can happen if a chest tube is clamped?	Tension pneumothorax. Should never be clamped.
Chest tubes can be water sealed, to gravity or connected to _________	suction
The drainage bottle of a chest tube should always be kept ________ the level of the patient, otherwise its contents will siphon back into the chest cavity.	Below
Nursing management of a chest tube. What to look for	1. Assess vital signs, lung sounds, and pain. 2. Assess for manifestations of reaccumulation of air & fluid in the chest (↓ or absent breath sounds) & signs of infection 3. Assess for SQ emphysema at tube site. 4. Encourage the patient to breathe deeply periodically to facilitate lung expansion and to prevent atelectasis or pneumonia
Drainage of a chest tube how much is to much?	Book: >100mL of drainage class: pint (450 mL) Consistency or color change should be reported to the physician
After a chest tube is removed should a CXR be performed?	yes
Most common type of traumatic chest injury	Fractured Ribs 5-10 most commonly fractured Remember whats underneath!
Two or more ribs in two or more separate locations will cause this	Flail chest
What type of movement is associated with flail chest?	Paradoxical movement: respiration are reversed, with the chest wall moving in during inspiration and out during expiration
15% of all MVA deaths are due to this. It occurs due to a shearing or compression (between sternum and spine)	Aortic tear
Aortic tears can cause cardiac tamponade. What is cardiac tamponade?	Rapid collection of blood in the pericaridal sac, reducing filling
S/S of cardiac tamponade (medical emergency)	Muffled, distant heart tones ↓B/P NVD ↑CVP
Cardiac contusion what is the most common arrhythmia?	VTach
Drug of choice for hemothorax and why?	Toradal- NSAID- anti- inflammatory. No more then 5 days due to ulcers
Who can remove a chest tube?	Physician or APRN (unless patient is deceased)
What to do if a chest tube is disconnected or is pulled out?	Reconnect immediately. If its completely out cover with a 3 sided dressing
Cardiac Tamponade	Rapid collection of blood in the pericaridal sac, reducing filling

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453: Test 1 Chest Trauma and Thoracic Injuries

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