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) [Show Less]