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43 Cards in this Set
- Front
- Back
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Two types of chest trauma
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blunt and penetrating
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Why is chest trauma life threatening
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hypoxemia, hypovolemia, cardiac failure
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Quick assessment skills for chest trauma
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how did it happen? when?
patient responsive and breathing? auscultate breath and heart sounds Get an IV line in |
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Diagnostics for chest trauma
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CXR, CBC, EKG, ABG, clotting studies, type and cross, electrolytes, CT
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Complications of rib fractures
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pneumothorax
lacerate SVC puncture liver/spleen fracture itself is treated conservatively to control pain |
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Flail Chest
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multiple rib fracture causing free floating rib section and unstable chest wall
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Signs and symptoms of flail chest
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increased HR, increased RR, low BP, respiratory acidosis
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Treatment for flail chest
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depends on severity
If severe...intubate and add PEEP |
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What is the goal with a hemo or pneumothorax?
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get rid of blood/air from pleural space
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Symptoms of tx for hemo/pneumothorax?
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dyspnea to shock
depends on severity |
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How is hemo/pneumothorax diagnosed?
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chest x ray
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Treatment for hemo/pneumothorax?
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chest tube
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Tension pneumothorax
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air goes in with inspiration and stays in with expiration
increased pressure that pushes the lung, heart, and trachea to the opposite side Medical emergency! |
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What is treatment for tension pneumothorax?
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large bore needle 2ICS MCL
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Open pneumothorax
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sucking chest wound
inspiration goes in expiraction goes out Heart and vessels move back and forth |
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Treatment for open pneumothorax
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cover hole
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Goal for gunshot wounds and stabs
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restore and maintain cardiac and pulmonary function
Evaluate quickly! |
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Treatment for gunshot wounds and stabs
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depends on injury
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Pulmonary contusion
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bruise and swelling of lung tissue
can't perfuse through a bruise |
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Treatment of pulmonary contusion
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depends on severity/size
Ranges from monitoring to full ventilatory support |
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Cardiac tamponade
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compression of the heart from fluid in the pericardial sac
MEDICAL EMERGENCY |
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S/S of cardiac tamponade
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depend on how quickly it comes
Low BP, distant heart sounds, pulsus paradoxus, SOB, tachypnea, anxiety |
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At risk for Cardiac tamponade
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surgical patients
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Treatment
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pericardiocentisis
thoracotomy |
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Subcutaneous Emphysema
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crepitus; rice crispies under skin
air passage and/or lung injuries and air enters under the skin |
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what do you do with subcutaneous emphysema
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check around chest tubes and trachs too/ usually harmless and self limiting
mark site and chest if size increases |
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Aspiration
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serious! can cause death
vomit, food, drowning, or tube feeds |
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When does aspiration usually occur?
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reflexes are lacking (unconscious, after prolonged intubation)
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Therapeutic Interventions for aspiration
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quick assessment, ABC
treat and watch for hypoxemia, hypovolemia, cardiac failure Know chest tubes and ventilators, explain who are you and what you're doing offer support to patients/family |
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Hypovolemic shock
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volume loss of blood
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Cardiogenic shock
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due to impairment of hearts' ability to pump blood
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Shock that occurs in trauma
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both cardiogenic and hypovolemic shock
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Assess shock
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look at algorhythm...what can we do? what clinical cues? treatments?
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Pulmonary embolus
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obstruction of one or more branches of the pulmonary artery that originates in the venous system and mostly in deep veins of the legs
Ventilation without perfusion |
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Clinical findings of pulmonary embolus
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severe sudden dyspnea
extreme anxiety/restlessness sharp pain in the chest fever coughing and hemoptysis on auscultation, dullness over area of infarction |
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Diagnostic evaluation of PE
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CXR, EKG, ABGs, VQ SCAN, Pulmonary angiography, spinal CT (gold standard)
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Emergency Nursing Care
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High Fowler's
Oxygen Start IV Relieve pain/anxiety dissolve clot/prevent other clots |
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Thrombolytic therapy for PE
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urokinase/streptokinase
high risk for bleeding dissolves clot |
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Anticoagulation therapy for PE
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coumadin
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Other therapies for PE
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pulmonary embolectomy
vena cava filters |
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Risk factors for PE
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venous stasis
Hypercoagulation Venous disease Disease states |
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What is best for PE
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prevention!
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Therapeutic interventions
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assess, diagnose, plan care, outcomes
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