Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
181 Cards in this Set
- Front
- Back
|
What is chest trauma with skin intact and damage inside
|
blunt
|
|
|
Two types of chest trauma
|
blunt
penetrating |
|
|
What is chest trauma with something sticking into lungs
|
penetrating
|
|
|
How do you open airway if patient has collar on or C spine injury?
|
jaw thrust or emergency trach
|
|
|
What would you do for a trauma patient?
|
2 large bore IV to get fluids in right away
EKG Labs Chest Xray |
|
|
How long do you leave collar on patient with C spine?
|
until cleared
|
|
|
Why is chest trauma life threatening?
|
hypoxemia, hypovolemia, cardiac failure
|
|
|
Why do you want to know WHEN chest trauma occurred?
|
golden hour to know how close to death and chances of survival
|
|
|
What do you assess in chest trauma patient
|
How? When? ABC? responsive and breathing? auscultate breath and heart sounds, Get IV in
|
|
|
Where is best place to put in an IV during chest trauma or emergency
|
antecubital or jugular because you need a large vein
|
|
|
Diagnostics you can run for chest trauma?
|
CXR, CBC, EKG, ABG, clotting studies, type and cross, electrolytes, CT, Foley, Kidney, Liver, Tox screen, Vitals, pulse ox, BP, LOC, JVD
|
|
|
Why do you check tox screen if chest trauma
|
may have been etiology for accident
|
|
|
Why do you check blood sugar with chest trauma?
|
could cause accident
|
|
|
Why do you do chest xray for chest trauma
|
fractures, pneumo/hemothorax, cardiac silhouette, foreign debris, trach deviation, cardiac tamponade
|
|
|
Why do you assess EKG with chest trauma
|
for myocardial damage, STE, rate, rhythm, tachy? PVC?
|
|
|
what do you look for in ABG of chest trauma
|
hypoxia, respiratory acidosis, CO2
|
|
|
What clotting studies are done in chest trauma
|
PT, PTT, INR
|
|
|
Why do you do type and cross with chest trauma?
|
anticipate transfusion
|
|
|
When might you not do type and cross
|
Jehovah Witness
|
|
|
What should you do before type and cross
|
check if Jehovah Witness or if they don't receive blood products
|
|
|
What electrolytes are important to monitor if chest trauma
|
potassium or sodium
Potassium could explain PVC or Output Sodium in case had seizure |
|
|
Why do you check CPK, Troponin in chest trauma?
|
for cardiac damage
|
|
|
Why do you put in Foley with chest trauma
|
to measure output and to check for blood that may show abdominal injury
|
|
|
Why do you measure BUN and Cr with chest trauma
|
kidney damage
|
|
|
Why do you do liver studies with trauma
|
liver damage
|
|
|
What do you need if you give blood without patient consent?
|
physician order
|
|
|
Why do fractures to upper ribs have such high mortality?
|
because large vessels like aortic arch and SVC are in this area
|
|
|
Why do you check LOC and JVD in chest trauma
|
decrease blood or decrease oxygen
|
|
|
What does belly stick check for
|
blood in abdomen
|
|
|
How often monitor BP with chest trauma?
|
every 5 minutes
|
|
|
what are complications of rib fractures
|
pneumothorax
lacerate SVC or aortic arch puncture liver/spleen |
|
|
How is fracture treated?
|
conservatively: control pain because it hurts to breathe!
|
|
|
What can pain lead to with rib fracture?
|
pneumonia and atelectasis
|
|
|
If you have multiple rib fractures and comorbidities, you have....?
|
increased mortality
|
|
|
What does mortality of flail chest depend on
|
comorbidities and age
|
|
|
What is flail chest
|
multiple rib fractures cause free floating section and unstable chest wall
|
|
|
Breathing in flail chest?
|
paradoxical
in on inspiration out on expiration |
|
|
S/S flail chest
|
paradoxical movement, increase RR, increase HR, low BP, respiratory acidosis
|
|
|
Treatment for flail chest
|
depends on severity
|
|
|
What do you do with severe flail chest?
|
intubate and add PEEP
|
|
|
What is the goal with pneumo/hemo thorax?
|
get rid of blood/air from pleural space
|
|
|
What are symptoms for pneumo/hemo thorax?
|
depend on severity: dyspnea to shock
|
|
|
How can we cause pneumo/hemo thorax?
|
triple lumen line placement, surgery
|
|
|
How do you diagnose pneumo/hemo thorax?
|
chest xray
|
|
|
Treatment for pneumo/hemo thorax?
|
chest rube
|
|
|
When do you USUALLY insert chest tube?
|
over 20% of lung affected
|
|
|
What do you do after triple lumen
|
chest xray
|
|
|
What does chest tube placement depend on?
|
patient
age, COPD, percent of lung involved |
|
|
When might the chest tube be placed in lower?
|
hemothorax; blood sinks
|
|
|
When can you clamp chest tube?
|
ONLY when insert and remove!
|
|
|
Why can't you clamp chest tube
|
can cause tension pneumothorax
|
|
|
What is a big sign of tension pneumothorax?
|
tracheal deviation
|
|
|
What occurs in tension pneumothorax?
|
air goes in on inspiration and stays in on expiration, causing increased pressure that pushes the lung, heart, and trachea to the opposite side
MEDICAL EMERGENCY |
|
|
What is treatment for tension pneumothorax?
|
large bore needle 2nd intercostal space midclavicular line then chest tube later
|
|
|
What is the sound when you insert needled into tension pneumothorax?
|
pop as pressure released; sounds like opening a can of soda
|
|
|
What must happen before removing chest tube
|
lung must be healed
|
|
|
How do you know when to remove tube?
|
no fluid or little fluid in chest
good chest xray lung inflated fully stable patient |
|
|
What is open pneumothorax?
|
sucking chest wound
inspiration air goes in and expiration air goes out (through hole) |
|
|
What must you do with open pneumothorax?
|
evaluate quickly
|
|
|
treatment for open pneumothorax?
|
cover hole! until surgery
|
|
|
what happens to heart and vessels with open pneumothorax?
|
move back and forth
|
|
|
What is goal with gunshot wounds and stab wounds?
|
restore and maintain cardiac/pulmonary function
|
|
|
What is treatment for gunshot wounds and stab wounds?
|
depends on injury
|
|
|
What should you NEVER do with gunshot wounds and stab wounds?
|
pull it out!
|
|
|
What do you do with gunshot wounds and stab wounds?
|
support it
|
|
|
What do you look for with gunshot wounds and stab wounds?
|
check entrance and exit
|
|
|
If there is no exit with gunshot wounds and stab wounds, what does that mean?
|
it's still inside
|
|
|
What may have happened with a GSW if only a small hole
|
may have entered body and ricocheted around
|
|
|
If there is one GSW, there is...
|
probably more
|
|
|
what is a pulmonary contusion?
|
bruise and swelling of lung tissue
|
|
|
What is treatment for pulmonary contusion?
|
monitoring to full ventilatory support
depends on severity/size |
|
|
How long should you watch pulmonary contusion
|
12 hours
|
|
|
What is cardiac tamponade?
|
compression of the heart from fluid in the pericardial sac
|
|
|
What are s/s of cardiac tamponade?
|
depends on how quickly it comes
Low BP, distant heart sounds (listen through blood), SOB, tachypnea, anxiety, pulsus paradoxus (uneven pulses) |
|
|
What is treatment for cardiac tamponade?
|
pericardiocentesis
thoracotomy |
|
|
Why are heart sounds distant with cardiac tamponade?
|
listening through blood
|
|
|
What is cardiac tamponade?
|
medical emergency!
|
|
|
What does cardiac tamponade cause?
|
decrease in SV and CO
|
|
|
Will increasing preload help cardiac tamponade?
|
NO! it's a mechanical malfunction
no matter the preload or afterload, it won't help! |
|
|
Why do you run CXR with cardiac tamponade?
|
to look at cardiac silhouette
|
|
|
What is subcutaneous emphysema?
|
air passage under the skin that sounds like rice crispies under the skin
|
|
|
Where do you check for subcutaneous emphysema?
|
around chest tubes and trachs
|
|
|
What do you do if you noticed subcutaneous emphysema?
|
mark site and outline with pen and let someone know
you can monitor if grows or decreases |
|
|
How do you find subcutaneous emphysema?
|
ONLY feeling with fingertips
|
|
|
When should you NOT put a patient in high fowlers
|
if BP too low
|
|
|
What is the problem with aspiration?
|
serious and can cause death
|
|
|
What are some causes of aspiration?
|
vomit, food, drowning
|
|
|
When does aspiration usually occur
|
when reflexes are lack
|
|
|
How often do you check and document residual with peg tube?
|
every 4 hours!!
|
|
|
How can we cause aspiration
|
tube feeds if we don't check tube placement
|
|
|
Why is aspiration common with chest trauma
|
NOT NPO for 12 hours before surgery and often eat during accidents
|
|
|
When should you hold feed?
|
if over 2-3 hours worth of feed in stomach
|
|
|
How can you check NG tube placement?
|
auscultation for air LUQ and bubbles
aspirate contents chest Xray |
|
|
What is gold standard to check NG placement
|
CXR
|
|
|
You should document that you checked NG placement how many times
|
at least 2
|
|
|
What should you do with PEG tube before feed?
|
check placement!
especially if obese!! |
|
|
What should you watch for with chest trauma
|
hypoxemia, hypovolemia, cardiac failure
|
|
|
Hypovolemic shock
|
due to volume loss of blood: decrease preload, decrease SV, decrease afterload, increase HR
|
|
|
Cardiogenic shock
|
due to impairment of heart's ability to pump blood; decrease SV
|
|
|
Some causes of cardiogenic shock
|
MI, chest trauma, myo problems
|
|
|
What type of shock do patients with trauma usually experience?
|
cardiogenic AND hypovolemic
|
|
|
What can we give if had MI and systolic BP 68
|
increase fluid and give catecholamines (to increase contractility)
|
|
|
What is PE
|
obstruction of one or more branches of pulmonary artery
|
|
|
only venous artery in body
|
pulmonary arteries
|
|
|
What do PE's arise?
|
venous system
|
|
|
Where do most thrombus originate?
|
deep veins of legs but can't be anywhere
|
|
|
why is PE a problem?
|
ventilation without perfusion
can breathe but can't perfuse |
|
|
What are s/s of PE?
|
same as MI
severe sudden dyspnea extreme anxiety, restlessness sharp pain in chest fever coughing with hemoptysis (not always) dullness over area upon auscultation |
|
|
Diagnostics for PE
|
CXR, EKG, ABG, pulmonary angiography, spiral CT
|
|
|
What is the gold standard to diagnose PE
|
spiral CT; goes in slices by the pulmonary artery to SEE obstruction
|
|
|
What may person with PE seem like
|
increase pulse, increase BP at first, decrease PaO2
|
|
|
Can you treat PE with O2
|
no, because it won't get through
|
|
|
What is order of care for PE
|
High Fowlers, Oxygen, Start IV, relieve pain/anxiety, dissolve clot/prevent others from forming
|
|
|
What is thrombolytic therapy for PE
|
urokinase/streptokinase
high risk for bleed dissolves clot CANNOT do with surgical patients! |
|
|
Some anticoag thearpy for PE
|
coumadin
|
|
|
Other therapies for PE
|
pulmonary embolectomy
vena cava filter |
|
|
What is pulmonary embolectomy
|
go to cath lab, go up to P.A. and remove clot; not common
|
|
|
What is vena cava filter
|
for patients with multiple PE or if can't handle anti coag; it catches the clots and has fibronolysis to break down clot
|
|
|
What are risk factors for PE
|
venous stasis, hypercoagulation (surgery, disorders), venous disease (Diabetes, large legs), disease states (hypertension, CAD, PVD)
|
|
|
What is best for PE
|
PREVENTION!
TED hose, compression stockings, LMWH/Lovenox |
|
|
what do you do with those on bedrest?
|
anticipate PE and DVT; do Dopplers!
|
|
|
Why don't you follow PTT if on heparin or Lovenox twice daily?
|
dose won't be steady in blood; have peak and trough
|
|
|
Why do you monitor platelets if on heparin therapy
|
can get heparin induced platelet allergy which will cause platelets to drop!
|
|
|
How do you flush hep lock and why
|
with normal saline to prevent Heparin induced platelet allergy
|
|
|
Pleural space
|
potential space, usually parietal and viceral pleurae stick together with surfactant
|
|
|
When do you do chest tube
|
usually if pneumothorax is 20% or greater
|
|
|
Single bottle chest drainage system
|
water seal
cup with a straw in it; inhale and water moves up and exhale water moves down; air can't go into lung through tube |
|
|
What should you always have in room with chest tube
|
bottle of sterile water or 0.9% N/S
|
|
|
Two bottle chest tube system
|
water seal PLUS suction usually at 20 cm H20 continuously to promote drainage
|
|
|
Can you take suction off chest tube?
|
yes, as long as you still have waterseal
|
|
|
3 bottle chest tube drainage system
|
water seal PLUS suction PLUS separate drainage container to measure what's coming out
|
|
|
How often do you measure chest tube drainage
|
depends on policy
|
|
|
What position do you place a person with chest tube
|
usually Fowlers
but any position is fine EXCEPT laying on tubing |
|
|
Can patients ambulate with chest tube
|
YES! THEY SHOULD! you carry chest tube system while patient walks
|
|
|
What is dressing for chest tube
|
vaseline gauze or split 4x4 covered with tape
change prn or hospital policy |
|
|
What are flucuations with chest tubes?
|
water rises with inspiration adn falls with expiration
|
|
|
When do you see no fluctuations in chest tubes system
|
if tubing is occluded or if lung is totally re-expanded
|
|
|
What does it mean if bubbles are seen in the "left arm" of the water seal chamber
|
there is an air leak!!!
|
|
|
What do you do if there is an air leak in the chest tubes system
|
check connections, container, and site! if still leak, CALL PHYSICIAN!!!
|
|
|
What should you do with chest tubes drainage system at end of shift?
|
mark the site to figure out I and O
|
|
|
What will color of chest tube drainage be like?
|
depends on placement
early after surgery- lots of output and blood |
|
|
When should you call the physician in terms of chest tubes drainage?
|
if over 100 cc/hr!!!
could be actively bleeding! |
|
|
What should you NOT do to chest tube
|
clamp or milk or strip
may cause damage |
|
|
What do you do with clot in chest tubing?
|
tap on tubing or gently kneed to work out
|
|
|
What do you do if patient with chest tubes has difficult breathing
|
assess patient and tube, look at whole picture (may be caused by pain), could be tension pneumo, PE, or hemorrhage
|
|
|
What does TCDB do?
|
promote reexpansion of lung, drainage, prevent atelectasis, medicate frequently for pain
|
|
|
How do you pull out chest tube
|
check policy
have patient valsava, clamp and pull out, cover with vaseline gauze and 4x4 |
|
|
What does a high ventilatory alarm mean?
|
obstruction
kink or goo probably secretions anticipate suction |
|
|
What does a low ventilatory alarm mean?
|
leak
disconnection extubate |
|
|
What do you do if ventilatory alarm sounds and you're in doubt of what to do
|
ambu
|
|
|
What emergency equipment should be at bedside with ventilator
|
ambu, suction, o2
|
|
|
Who puts in chest tube
|
NP or MD
|
|
|
what does it mean if bobber in chest tube is moving up and down?
|
suction is on
|
|
|
How do you tell if coumadin or heparin therapy has been effective
|
optimum PT, PTT, INR
no new DVT or PE |
|
|
What is normal PTT on heparin therapy
|
2-2.5 times normal
|
|
|
What is normal PTT
|
20-30
|
|
|
What are heparin protocols based on?
|
weight
|
|
|
When do you monitor PTT when on heparin
|
4 hours, then Q 6 hours after
|
|
|
What is normal hep therapy?
|
bolus then continuous (5,000 units)
|
|
|
What is point of heparin therapy
|
prevent clots
|
|
|
How is protamine sulfate given
|
IV ONLY!
|
|
|
What is protamine sulfate given for
|
too much heparin
|
|
|
What is the antidote for heparin
|
protamine sulfate
|
|
|
How should you give protamine sulfate
|
IV SLOWLY!
|
|
|
Why can't you give protamine sulfate IV quickly?
|
drop BP
|
|
|
What is antidote for Coumadin/Warfarin?
|
Vitamin K
|
|
|
Why do you give Coumadin WHILE on heparin?
|
to try to ease off Heparin
|
|
|
What do you monitor while on Coumadin
|
PT and INR
|
|
|
What is normal INR
|
1
|
|
|
What is INR on coumadin
|
2-3
|
|
|
What are bleeding precautions
|
no hard toothbrush
fall risk don't cut nails no sticks watch while shaving |
|
|
What is cause of code with PE
|
hypoxia
|
|
|
When do you stop Heparin therapy
|
if PTT OVER 100!!
|
|
|
Why do you stop heparin if PTT over 100
|
greater risk of bleeding than you have of getting another PE
|
|
|
What would an INR of 7 mean to the nurse
|
SAFETY! HIGH RISK FOR BLEED!
GIVE VITAMIN K IV OR SUBQ! |
|
|
When should you hold heparin
|
based on protocol or over 100 PTT
|
|
|
Why is Coumadin given at night?
|
because we check labs in the morning and it will reflect a steady state
|
|
|
What do you do if theres a stick ordered and the INR is too high
|
call physician and document
|
|
|
What happens in blood in stool but no signs of bleeding?
|
contact MD or if worried, call 911
|
|
|
What happens if the patient turns off their heparin drip?
|
restart and call teh MD
|
|
|
what diet precautions should a patient be given when on coumadin
|
do not increase or decrease anything in your diet!
|
