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;
52 Cards in this Set
- Front
- Back
|
What is the initial emergency approach to all chest injuries?
|
ABC (airway, breathing, circulation) followed by rapid assessment and treatment of life-threatening conditions
|
|
|
What is the most common chest injury seen in the United States?
|
Pulmonary contusion
|
|
|
What is the pathophysiology of a pulmonary contusion?
|
1. After a contusion, respiratory failure develops over time rather than immediately
2. This condition most often follows injuries caused by rapid deceleration during vehicular accidents 3. Hemorrhage occurs in and between the alveoli 4. The resulting edema decreases pulmonary compliance and reduces the area for gas exchange 5. The client becomes hypoxemic and dyspneic 6. The bronchial mucosa is irritated and secretions increase |
|
|
What is the common cause of pulmonary contusion?
|
Rapid deceleration during vehicular accidents
|
|
|
What are the clinical manifestations of pulmonary contusion?
|
1. Clients with pulmonary contusion may be asymptomatic at first and can later develop respiratory failure
2. Hemoptysis 3. Decreased breath sounds, crackles, and wheezes 4. Initially, the chest x-ray may show no abnormalities. A hazy opacity in the lobes or parenchyma may develop over several days. 5. If there is no disruption of the parenchyma, resorption of the lesion often occurs without treatment |
|
|
What are the interventions for pulmonary contusion?
|
1. Maintenance of ventilation and oxygenation
2. Central venous pressure (CVP) is monitored closely 3. Fluid intake is restricted as needed 4. The client in obvious respiratory distress may need mechanical ventilation with positive end-expiratory pressure (PEEP) to inflate the lungs |
|
|
What are the complications of pulmonary contusion?
|
1. A vicious cycle occurs in which more muscle effort is needed for ventilating a lung with a contusion and the client becomes progressively hypoxemic
2. This situation causes the client to tire easily, have reduced gas exchange, and become more fatigued and hypoxemic 3. Flail chest may also occur when pulmonary contusion occurs with parenchymal damage 4. This condition often leads to acute respiratory distress syndrome (ARDS) |
|
|
What causes rib fractures?
|
1. Most often result from direct blunt trauma to the chest
2. Direct force fractures the ribs and drives the bone ends into the thorax |
|
|
What are the complications of rib fractures?
|
1. Intrathoracic injury, such as pulmonary contusion or pneumothorax, which occurs most often if ribs one through four are fractured
2. If the client has pre-existing pulmonary disease, the risk for atelectasis and pneumonia increases 3. Clients with injuries to the first or second ribs, flail chest, seven or more fractured ribs, or expired volumes of less than 15 mL/kg often have an intrathoracic injury and a poor prognosis |
|
|
What is a common clinical manifestation of rib fracture?
|
The client has pain on movement and splints the chest defensively
|
|
|
What complications can result from splinting?
|
Splinting reduces breathing depth and leads to inadequate clearance of pulmonary secretions
|
|
|
What is the treatment for uncomplicated rib fracture?
|
1. Treatment is nonspecific because the fractured ribs reunite spontaneously
2. The chest is usually not splinted by tape or other materials |
|
|
What is the main focus of rib fractures?
|
To decrease pain so that adequate ventilation is maintained
|
|
|
What is pain management for rib fracture?
|
1. An intercostal nerve block may be used if pain is severe
2. Potent analgesics that cause respiratory depression are avoided |
|
|
What is flail chest?
|
The inward movement of the thorax during inspiration, with outward movement during expiration, and usually involves only one side of the chest
|
|
|
What causes flail chest?
|
1. Multiple rib fractures caused by blunt chest trauma leaving a segment of the chest wall loose
2. Bilateral separations of the ribs from their cartilage connections to each other anteriorly, without an actual rib fracture. This condition can occur during cardiopulmonary resuscitation on an older adult. |
|
|
What is the clinical manifestation of flail chest?
|
1. Paradoxic expansion and contraction of the rest of the chest wall
2. Dyspnea 3. Cyanosis 4. Tachycardia 5. Hypotension |
|
|
What is paradoxic chest movement?
|
The "sucking inward" of the loose chest area during inspiration and a "puffing out" of the same area during expiration
|
|
|
What are the complications of flail chest?
|
1. Gas exchange is impaired, as is the ability to cough and clear secretions
2. Defensive splinting further reduces the client's ability to exert the extra effort required for breathing and may contribute later to failure to wean |
|
|
How does flail chest affect the client?
|
The client is often anxious, short of breath, and in pain
|
|
|
What are the interventions for flail chest?
|
1. Humidified oxygen
2. Pain management 3. Promotion of lung expansion through deep breathing and positioning 4. Secretion clearance by coughing and tracheal aspiration 5. Mechanical ventilation may be needed if respiratory failure or shock occurs 6. Monitor arterial blood gas (ABG) values closely, along with vital capacity 7. With severe hypoxemia and hypercarbia, the client is intubated and mechanically ventilated with PEEP 8. With pulmonary contusion or an underlying pulmonary disease, the risk for respiratory failure increases 9. Flail chest is best stabilized by positive-pressure ventilation rather than surgical intervention 10. Surgical stabilization is used only in extreme cases of flail chest |
|
|
What is the best method for stabilizing flail chest?
|
By positive-pressure ventilation
|
|
|
When is surgical stabilization used?
|
Only in extreme cases of flail chest
|
|
|
What is the normal intrathoracic pressure?
|
756 mmHg
(less than that of atmospheric pressure, which is 760 mmHg) |
|
|
What causes pneumothorax?
|
Blunt chest trauma that allows air to enter the pleural space
(some degree of hemothorax usually occurs as well) |
|
|
What are the clinical manifestations of pneumothorax?
|
1. Reduced breath sounds on auscultation
2. Hyperresonance on percussion 3. Prominence of the involved side of the chest, which moves poorly with respirations 4. Deviation of the trachea away from (closed) or toward (open) the affected side 5. In addition, the client may have pleuritic pain, tachypnea, and subcutaneous emphysema (air under the skin in the subcutaneous tissues) |
|
|
How is pneumothorax diagnosed?
|
A chest x-ray is used for diagnosis
|
|
|
How is pneumothorax treated?
|
Chest tubes may be needed to allow the air to escape and the lung to reinflate
|
|
|
What is tension pneumothorax?
|
A rapidly developing and life-threatening complication of blunt chest trauma, results from an air leak in the lung or chest wall
|
|
|
What are the effects of tension pneumothorax?
|
1. Air forced into the chest cavity causes complete collapse of the affected lung
2. Air that enters the pleural space during expiration does not exit during inspiration 3. As a result, air continues to accumulate under pressure, compressing blood vessels, and limiting venous return 4. Because this process leads to decreased filling of the heart, cardiac output is reduced |
|
|
What happens if tension pneumothorax is not promptly detected and treated?
|
It is quickly fatal
|
|
|
What are the causes of tension pneumothorax?
|
1. Blunt chest trauma
2. Mechanical ventilation with positive end-expiratory pressure (PEEP) 3. Closed-chest drainage (chest tubes) 4. Insertion of central venous access catheters |
|
|
What are the clinical manifestations of tension pneumothorax?
|
1. Asymmetry of the thorax
2. Tracheal deviation to the unaffected side 3. Respiratory distress 4. Absence of breath sounds on one side 5. Distended neck veins 6. Cyanosis 7. Hypertympanic sound on percussion over the affected side |
|
|
What are the diagnostic tests of tension pneumothorax?
|
1. Pneumothorax is detectable on a chest x-ray
2. ABG assays show hypoxia and respiratory alkalosis |
|
|
What are the interventions for tension pneumothorax?
|
1. A large-bore needle is inserted into the second intercostal space in the midclavicular line of the affected side as initial treatment for tension pneumothorax
2. After this measure is completed, a chest tube is placed into the fourth intercostal space, and the other end is attached to a water seal drainage system until the lung reinflates |
|
|
What is a common problem occurring after blunt chest trauma or penetrating injuries?
|
Hemothorax
|
|
|
What is a simple hemothorax?
|
A blood loss of less than 1500 mL into the chest cavity
|
|
|
What is a massive hemothorax?
|
A blood loss of more than 1500 mL
|
|
|
What causes bleeding?
|
Injury to the lung tissue, such as pulmonary contusions or lacerations, that can occur with rib and sternal fractures
|
|
|
Where does massive intrathoracic bleeding in blunt chest trauma stem from?
|
The heart, great vessels, or the intercostal arteries
|
|
|
What are the clinical manifestations of small hemothorax?
|
Asymptomatic
|
|
|
What are the clinical manifestations of massive hemothorax?
|
1. Respiratory distress
2. Diminished breath sounds on auscultation 3. Percussion on the involved side results in a dull sound 4. Blood in the pleural space is visible on a chest x-ray and confirmed by diagnostic thoracentesis |
|
|
What are the interventions for hemothorax?
|
1. Interventions are aimed at removing the blood in the pleural space to normalize pulmonary function and to prevent infection
2. Anterior and posterolateral chest tubes are inserted to evacuate the pleural space 3. Carefully monitor the chest tube drainage. The physician evaluates chest x-rays serially to determine treatment effectiveness. 4. An open thoracotomy may be needed when there is initial evacuation of 1500 to 2000 mL of blood or persistent bleeding at the rate of 200 mL/hr over 3 hours 5. Monitor the vital signs, blood loss, and overall intake and output 6. Assess the client's response to the chest tubes, and infuse IV fluids and blood as prescribed 7. Autotransfusion of the blood lost through chest drainage may be considered |
|
|
When would an open thoracotomy be needed?
|
When there is initial evacuation of 1500 to 2000 mL of blood or persistent bleeding at the rate of 200 mL/hr over 3 hours
|
|
|
What causes tears of the tracheobronchial tree?
|
Severe blunt trauma or rapid deceleration
|
|
|
What do tears of the tracheobronchial tree often involve?
|
Mainstem bronchi
|
|
|
Where do injuries to the trachea usually occur?
|
At the junction of the trachea and cricoid cartilage
|
|
|
What causes injuries to the trachea?
|
These injuries are often caused by striking the neck against the dash-board or steering wheel during a motor-vehicle crash
|
|
|
What are the complications of tracheal tears?
|
1. Massive air leaks, which cause air to enter the mediastinum and extensive subcutaneous emphysema
2. Upper-airway obstruction may also occur, causing severe respiratory distress and inspiratory stridor 3. Tension pneumothorax may rapidly develop once he or she is intubated and ventilated with positive pressure |
|
|
What is the management of large tracheal tears?
|
Cricothyroidotomy or tracheotomy below the level of injury
|
|
|
What are the interventions for tracheobronchial trauma?
|
1. Assess the client for hypoxemia by ABG assays
2. Apply oxygen as needed 3. Depending on the degree of injury, the client may need mechanical ventilation or surgical repair 4. Assess vital signs every 15 minutes because the client is likely to be hypotensive and in shock 5. Continue to assess for subcutaneous emphysema and auscultate the lungs every 1 to 2 hours |
|
|
What are the complications of tracheobronchial trauma?
|
Decreased breath sounds or wheezing may indicate further obstruction, atelectasis, or pneumothorax
|
