Penetrating Chest Trauma: This can be
-hemothorax
-pneumothorax
-tension pneumothorax
-open pneumothorax (sucking chest
... [Show More] wound)
Hemothorax/Pneumothorax: This is when
blood or air has accumulated in the pleural space and the lung has collapsed
Hemothorax/Pneumothorax: Signs/Symptoms include
-SOB
-increased HR
-diminished breath sounds on the affected side
-less movement on the affected side
-chest pain
-cough
-subQ emphysema
Hemothorax/Pneumothorax Signs/Symptoms: What will should up on the x-ray?
air or blood
Hemothorax/Pneumothorax Signs/Symptoms: What is subcutaneous emphysema?
air trapped in the tissue (usually neck, face, and chest)
RULE: NEVER _________________ a penetrating object
pull out
Hemothorax/Pneumothorax: Treatment includes
-thoracentesis
-chest tube
-daily chest x-ray
Tension Pneumothorax: Can be caused by
-trauma
-too much PEEP
-clamping a chest tube
-insertion of central venous lines
-taping an open pneumothorax on all 4 sides without an air valve
Tension Pneumothorax: This occurs when
pressure has built up in the chest/pleural space and has collapsed the lung which then causes mediastinal shift
Tension Pneumothorax: What is mediastinal shift?
when pressure pushes everything to the opposite side
Tension Pneumothorax: Signs/Symptoms include
-subQ emphysema
-absence of breath sounds on one side
-asymmetry of thorax
-respiratory distress
-cyanosis
-distended neck veins, or JVD
Tension Pneumothorax: JVD is a medical emergency and can be fatal as
accumulating pressure compresses vessels leading to decreased venous return resulting in decreased CO
Tension Pneumothorax: Treatment includes
-large bore needle
-treating the cause (chest tube will be inserted)
Tension Pneumothorax Treatment: Large bore needle is placed into the _________________________ (by the primary healthcare provider) to _______________________________
2nd intercostal space; allow excess air to escape
Open Pneumothorax: AKA
sucking chest wound
Open Pneumothorax: This is an
opening through the chest that allows air into the pleural space
Open Pneumothorax: Treatment includes
-have client inhale, Valsalva or hummmmmmm
-place petroleum gauze over the area
-have client sit up (if possible) to expand lungs
Open Pneumothorax Treatment: Having the client inhale, Valsalva or hummmmmmm is done to
increase the intra-thoracic pressure so no more outside air can get into the body
Open Pneumothorax Treatment: When placing a piece of petroleum gauze over the area, tape down _______ sides and the _______________ acts like a ________________ or _______________
3; 4th side; air vent; flutter valve
Open Pneumothorax Treatment: While clients are to sit up, if able, to expand their lungs, trauma clients _______________ until _____________________________
stay flat; evaluated for other injuries
Thoracic (Chest) Procedures: These include
-thoracentesis
-chest tubes
Thoracic (Chest) Procedures - Thoracentesis: This is performed to
remove fluid or air from the pleural space
Thoracic (Chest) Procedures - Thoracentesis: It is used for analysis of lungs fluids to
determine the cause of the effusion
Thoracic (Chest) Procedures - Thoracentesis: The fluid obtained may be
sent for culture or cancer cells
Thoracic (Chest) Procedures - Thoracentesis: Pre-procedure we must check for
informed consent
Thoracic (Chest) Procedures - Thoracentesis: Pre-procedure the client must STOP
any anticoagulant medications
Thoracic (Chest) Procedures - Thoracentesis: Pre-procedure we must obtain
-baseline VS
-oxygen saturation
-pain level
Thoracic (Chest) Procedures - Thoracentesis: Pre-procedure be sure that a ___________________ has been performed
CXR
Thoracic (Chest) Procedures - Thoracentesis: Pre-procedure positioning
sit on the edge of bed, with feet supported, and lean over the bedside table
Thoracic (Chest) Procedures - Thoracentesis: What if the client is not able to sit up pre-procedure?
have them lie on the unaffected side with HOB at 45 degrees
Thoracic (Chest) Procedures - Thoracentesis: During procedure the client must be
very still; no coughing or deep breaths
Thoracic (Chest) Procedures - Thoracentesis: During the procedure the ______________________ is being removed from ______________________
fluid/blood/exudate; the pleural space
Thoracic (Chest) Procedures - Thoracentesis: During the procedure, as the fluid is being removed, the lung should
reinflate
Thoracic (Chest) Procedures - Thoracentesis: During the procedure we should be checking ___________________________________ and compare to
VS, oxygen sats, pain level; baseline
Thoracic (Chest) Procedures - Thoracentesis: Post-procedure another ______________ is taken
CXR
Thoracic (Chest) Procedures - Thoracentesis: Post-procedure monitor
VS
Thoracic (Chest) Procedures - Thoracentesis: Post-procedure we must listen to ___________________ for __________________
lungs; absent or reduced breath sounds on the affected side
Thoracic (Chest) Procedures - Thoracentesis: Post-procedure we must check ___________________ and _________________ for bleeding
puncture site; dressing
Thoracic (Chest) Procedures - Thoracentesis: Post-procedure we must monitor for
-subQ emphysema
-infection
-tension pneumothorax
Thoracic (Chest) Procedures - Thoracentesis: Post-procedure we have the client
turn, cough, and deep breathe
Thoracic (Chest) Procedures - Chest Tubes: What has happened that the client needs a chest tube?
the lung has collapsed
Thoracic (Chest) Procedures - Chest Tubes: If the chest tube is placed in the upper anterior chest (2nd intercostal space) then it is for the removal of
air
Thoracic (Chest) Procedures - Chest Tubes: If the chest tube is placed laterally in the lower chest (8th or 9th intercostal space) then it is for
drainage
Thoracic (Chest) Procedures - Chest Tubes: Why is the tube placed in the upper chest for air removal and in the lower chest for removal of drainage?
because air rises and drainage settles
Thoracic (Chest) Procedures - Chest Tubes: The client can have both an upper and lower chest tube and they are _______________________ and attached to a ____________________
y-connected together; closed chest drainage unit (CDU)
Thoracic (Chest) Procedures - Chest Tubes: The chest tube is ____________________ and an occlusive dressing is applied ______________________________ and then the chest tube is connected to _______________________
sutured to the chest wall; around the chest tube exit site; a closed chest drainage unit
Thoracic (Chest) Procedures - Chest Tubes: What is the purpose of the CDU?
it is to restore the normal vacuum pressure in the pleural space
Thoracic (Chest) Procedures - Chest Tubes: How does the CDU restore the normal vacuum pressure in the pleural space?
by removing all air and fluid in a closed 1-way system until the problem is corrected
Thoracic (Chest) Procedures - Chest Tubes: What are the 3 chambers of the CDU?
1. drainage collection chamber
2. water seal chamber
3. suction control chamber
Thoracic (Chest) Procedures - Chest Tubes: The chest tube connects to a ____________________ that leads to the _____________________
6 foot connection tube; drainage collection chamber
Thoracic (Chest) Procedures - Chest Tubes: What if the drainage collection chamber fills up?
get a new CDU (rarely have to change)
Thoracic (Chest) Procedures - Chest Tubes: What is the purpose of the water seal chamber?
to promote 1-way flow out of the pleural space which will prevent air from moving back up the system and into the pleural space
Thoracic (Chest) Procedures - Chest Tubes: The drainage chamber and water seal chamber are connected by
a small tube that allows the drainage to remain in the first chamber and the air to go down into the water of the water seal chamber
Thoracic (Chest) Procedures - Chest Tubes: The water seal chamber contains ____________________ which acts as a ___________________. In other words, we are ______________________
2 cm of water; one-way valve; preventing backflow
Thoracic (Chest) Procedures - Chest Tubes: You may see ________________ in the water seal chamber when the client ________________________________________ (normal)
bubbling; coughs, sneezes, or exhales
Thoracic (Chest) Procedures - Chest Tubes: You will see a slight ____________________________ in the water seal tube as the client __________________
rise and fall; breathes
Thoracic (Chest) Procedures - Chest Tubes: The slight rise and fall seen in the water seal tube as the client breathes is called ________________ and is _______________
tildaling; normal
Thoracic (Chest) Procedures - Chest Tubes: If tidaling stops, it usually means that
the lung has re-expanded
Thoracic (Chest) Procedures - Chest Tubes: If the client needs suction to remove air and fluid, the suction control chamber does what?
controls the amount of suction applied
Thoracic (Chest) Procedures - Chest Tubes: Sterile water is placed in the suction control chamber up to the ___________________ which is the _____________________
20 cm line; usual prescribed amount
Thoracic (Chest) Procedures - Chest Tubes: Turn on the wall vacuum suction until you have
slow, gentle, continuous bubbling
Thoracic (Chest) Procedures - Chest Tubes: If a dry suction system is used, ___________________________ and therefore,
water is not needed to regulate the pressure; has no bubbling
Thoracic (Chest) Procedures - Chest Tubes: A _________ is used to set the negative pressure
dial
Thoracic (Chest) Procedures - Chest Tubes: Increasing the vacuum wall suction will NOT
increase the pressure
Management of Closed Chest Drainage System: Assess dressing; it must be kept
tight and intact
Management of Closed Chest Drainage System: Listen for breath sounds in _______________________ and monitor for ______________________
both lungs; breathing difficulty
Management of Closed Chest Drainage System: Monitor ____________________ and report anything below ___________
pulse oximetry; 90%
Management of Closed Chest Drainage System: Palpate chest tube insertion site for __________________ because this could indicate ________________________________
subQ emphysema; poor tube placement
Management of Closed Chest Drainage System: Record chest drainage every _______________ for 24 hours and then every _____________________
hour; 8 hours
Management of Closed Chest Drainage System: Notify primary healthcare provider of _____________ of drainage or greater in 1 hour
200 mL
Management of Closed Chest Drainage System: Notify primary healthcare provider of ____________ or greater any hour after the 1st hour
100 mL
Management of Closed Chest Drainage System: Notify primary healthcare provider of
change in color, like yellow to bright red
Management of Closed Chest Drainage System: Have client ______________________________ and use an __________________________
deep breathe, cough; incentive spirometer
Management of Closed Chest Drainage System: Watch for ______________________________ because they could develop an __________________ at insertion site
fever, increased WBCs, and drainage; infection
Management of Closed Chest Drainage System: Watch daily chest x-rays for
re-expansion
Management of Closed Chest Drainage System: Where would you obtain a chest drainage specimen?
chest tube (self-sealing)
Management of Closed Chest Drainage System: Keep the system _________________ the level of the chest
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