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43 Cards in this Set

  • Front
  • Back
Two types of chest trauma
blunt and penetrating
Why is chest trauma life threatening
hypoxemia, hypovolemia, cardiac failure
Quick assessment skills for chest trauma
how did it happen? when?
patient responsive and breathing?
auscultate breath and heart sounds
Get an IV line in
Diagnostics for chest trauma
CXR, CBC, EKG, ABG, clotting studies, type and cross, electrolytes, CT
Complications of rib fractures
pneumothorax
lacerate SVC
puncture liver/spleen
fracture itself is treated conservatively to control pain
Flail Chest
multiple rib fracture causing free floating rib section and unstable chest wall
Signs and symptoms of flail chest
increased HR, increased RR, low BP, respiratory acidosis
Treatment for flail chest
depends on severity
If severe...intubate and add PEEP
What is the goal with a hemo or pneumothorax?
get rid of blood/air from pleural space
Symptoms of tx for hemo/pneumothorax?
dyspnea to shock
depends on severity
How is hemo/pneumothorax diagnosed?
chest x ray
Treatment for hemo/pneumothorax?
chest tube
Tension pneumothorax
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!
What is treatment for tension pneumothorax?
large bore needle 2ICS MCL
Open pneumothorax
sucking chest wound
inspiration goes in
expiraction goes out
Heart and vessels move back and forth
Treatment for open pneumothorax
cover hole
Goal for gunshot wounds and stabs
restore and maintain cardiac and pulmonary function

Evaluate quickly!
Treatment for gunshot wounds and stabs
depends on injury
Pulmonary contusion
bruise and swelling of lung tissue
can't perfuse through a bruise
Treatment of pulmonary contusion
depends on severity/size
Ranges from monitoring to full ventilatory support
Cardiac tamponade
compression of the heart from fluid in the pericardial sac

MEDICAL EMERGENCY
S/S of cardiac tamponade
depend on how quickly it comes
Low BP, distant heart sounds, pulsus paradoxus, SOB, tachypnea, anxiety
At risk for Cardiac tamponade
surgical patients
Treatment
pericardiocentisis
thoracotomy
Subcutaneous Emphysema
crepitus; rice crispies under skin

air passage and/or lung injuries and air enters under the skin
what do you do with subcutaneous emphysema
check around chest tubes and trachs too/ usually harmless and self limiting

mark site and chest if size increases
Aspiration
serious! can cause death

vomit, food, drowning, or tube feeds
When does aspiration usually occur?
reflexes are lacking (unconscious, after prolonged intubation)
Therapeutic Interventions for aspiration
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
Hypovolemic shock
volume loss of blood
Cardiogenic shock
due to impairment of hearts' ability to pump blood
Shock that occurs in trauma
both cardiogenic and hypovolemic shock
Assess shock
look at algorhythm...what can we do? what clinical cues? treatments?
Pulmonary embolus
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
Clinical findings of pulmonary embolus
severe sudden dyspnea
extreme anxiety/restlessness
sharp pain in the chest
fever
coughing and hemoptysis
on auscultation, dullness over area of infarction
Diagnostic evaluation of PE
CXR, EKG, ABGs, VQ SCAN, Pulmonary angiography, spinal CT (gold standard)
Emergency Nursing Care
High Fowler's
Oxygen
Start IV
Relieve pain/anxiety
dissolve clot/prevent other clots
Thrombolytic therapy for PE
urokinase/streptokinase
high risk for bleeding
dissolves clot
Anticoagulation therapy for PE
coumadin
Other therapies for PE
pulmonary embolectomy
vena cava filters
Risk factors for PE
venous stasis
Hypercoagulation
Venous disease
Disease states
What is best for PE
prevention!
Therapeutic interventions
assess, diagnose, plan care, outcomes