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;
6 Cards in this Set
- Front
- Back
|
Indications
|
A) rapidly deteriorating critical patient who has a life threatening tension pnuemo
B) in the context of a suspected tension pneumothorax administer if -pt has severe respiratory distress with decreaed breath sounds, decreased CO/poor profusion/cyanosis -pt is deteriorating or in cardiac arrest |
|
|
Procedure
|
A. Bare the chest
B. ID the second intercostal space in the midclavicular line on the side of the pneumothorax C. prep the area using betadine and or alcohol swabs D. attach a 10 or 14 gauge over the needle cath 2-6 inch long over the syringe (18 gauge for peds) E. insert the needle into the skin and direct the needle just over (superior to the third rib in the intercostal space) F. aspirate while advancing needle until you obtain free air (if unable to aspirate air, check to see if skin plug) G. advance cath off needle H. connecting the cath to a one-way valve is optional, leave the plastic cath in place and apply a bandage or small dressing. Tape securely, proceed to ET intubation unless contraindicated K. assess respiratory status continuously L. if continuous, copious blood returns through the cath, occlude or remove the cath and apply a pressure dressing |
|
|
Complications
|
A. Local hematoma, or subQ emphasema
B. needle/cath kinking or clogging C. Damage to the intercostal nerve, artery or vein -converting a pneumothorax to hemopnuemothorax -resulting in intercostal neuritis/nueralgia D. damage to internal mammary vessels if puncture is too medical, resulting in hemopneumothorax E. Introduction of pleural infection (thoracic empeyema) F. laceration of puncture of intrathoracic organs e.g. lung/heart/vessels |
|
|
additional info
|
History suggestive of pneumothorax (simple or tension) includes
1. chest trauma 2. COPD 3. Positive Pressure Ventilation |
|
|
simple pnuemo
|
Suspect a simple pneumothorax if a patient has
1. respiratory distress 2. chest pain, chest wall, or pleuritic in nature 3. decreased or absent breath sounds on affected side 4. subQ emphysema/crepitation DO NOT DECOMPRESS |
|
|
tension pneumo
|
S&S of simple and...
1. shock, low cardiac output, hypotension 2. progressive respiratory distress 3. tracheal shift away from affected side 4. JVD 5. cyanosis or pallor 6. asymetrical chest movement on inspiration 7. hyperexpanded chest on affected side 8. drum like percusion 9. increased resistance to PPV, especialy if intubated and tube is patent |
