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30 Cards in this Set
- Front
- Back
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Trauma |
Any type of trauma to the chest wall (unintentional/accidental or intentional) |
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Flail Chest |
The result of double fractures of at least 3 or more adjacent ribs, causing the thoracic cage to become unstable (flail). |
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Etiology |
1. Industrial accidents 2. Vehicle accidents 3. Falls 4. Violence 5. Blast injury |
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Primary Assessment |
1. Past Medical History: History of injury 2. Cough: Possibly hemoptysis 3. Chest Appearance: Bruising over area involved 4. Respiratory Pattern: Paradoxical chest movement - flail chest. Shallow rapid respirations, severe chest pain 5. Color: Cyanotic 6. Breath Sounds: Diminished breath sounds over affected area 7. Vital Signs: Elevated HR and BP |
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Secondary Assessment |
1. Chest X-ray: Increased opacity from lung compression, rib fractures 2. ABG: Acute alveolar hyperventilation with hypoxemia 3. PFT: Decreased volumes and capacities |
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Treatment |
1. Oxygen therapy 2. Analgesics 3. Hyperinflation therapy (IS, SMI, IPPB) 4. Mechanical ventilation with PEEP for severe cases 5. Severe cases may require surgical stabilization of the chest wall 6. Bronchopulmonary hygiene 7. Prevention of pneumonia |
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Pneumothorax |
Gas or free air accumulated in the pleural space |
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Etiology - Pneumo |
1. Traumatic: Obvious injury 2. Spontaneous: No obvious injury |
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Primary Assessment - Pneumo |
1. Past History: Severe chest pain 2. Chest Appearance: Tracheal and/or mediastinal shift away from the affected side, increased volume on affected side, bruising over affected area 3. Respiratory Pattern: Tachypnea, reduced movement on affected side 4. Color: Cyanotic 5. Diagnostic Chest Percussion: Hyperresonant/tympanic note 6. Breath Sounds: Diminished or absent on affected side 7. Vital Signs: Small pneumo - tachycardia, hypertension; Large pneumo - bradycardia, hypotension and pulsus paradoxus. |
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Secondary Assessment - Pneumo |
1. Chest X-ray: Hyperlucency with absence of vascular markings on affected side, tracheal shift to unaffected side, depressed diaphragm, lung collapse 2. ABG: Small - Acute alveolar hyperventilation with hypoxemia; Large - Acute ventilatory failure with hypoxemia |
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Treatment - pneumo |
1. Small pneumo (< 20%): may only require bed rest and limited physical activity. Absorption usually occurs within 30 days 2. Large pneumo (> 20%): Should be evacuated by chest tube 3. Needle aspiration of chest necessary if patient is unstable (bradycardia, hypotension, cyanosis, etc.) 4. Oxygen therapy 5. Hyperinflation therapy after chest tube insertion 6. Mechanical ventilation with PEEP for acute ventilatory failure |
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Hemothorax |
Blood accumulated in the pleural space. |
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Etiology - Hemothorax |
Traumatic: Obvious injury |
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Primary Assessment - Hemothorax |
1. Past History: Severe chest pain 2. Vital Signs: Elevated HR and BP 3. Cough: Productive cough 4. Chest Appearance: Tracheal shift away from affected side, bruising over the affected area 5. Respiratory Pattern: Tachypnea, dyspnea depending on severity 6. Color: Cyanotic 7. Diagnostic Chest Percussion: Flat/dull note, decreased tactile and vocal fremitus 8. Breath Sounds: Diminished or absent on affected side, possibly pleural friction rub |
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Secondary Assessment - Hemothorax |
1. Chest X-ray: Increased radiodensity, tracheal shift away from affected side 2. ABG: Acute alveolar hyperventilation with hypoxemia 3. CBC: Reduced RBC/Hb/Hct |
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Treatment - Hemothorax |
1. Thoracentesis or chest tube to drain blood 2. Oxygen therapy 3. Hyperinflation therapy after chest tube 4. Mechanical ventilation with PEEP for acute ventilatory failure |
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Thermal Injuries |
Includes burns, smoke inhalation, and CO poisoning. The inhalation of smoke and hot gases, often accompanied by body surface burns. May lead to complete airway obstruction. Should be suspected in the presence of any type of fire. |
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Etiology - Thermal |
1. Fire victims 2. Firefighters 3. Inhalation of car exhaust |
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Primary Assessment - Thermal |
1. Past History: Firemen or patients pulled from a burning building, patients found sitting in garage with car running, trash fires 2. SOB: May be present 3. Cough: Excessive thick, black, sooty secretions 4. Respiratory Pattern: Tachypnea 5. Color: Cyanosis, "Cherry Red" (suspect CO poisoning) 6. Level of Consciousness: Alert, may be confused, unresponsive 7. Breath Sounds: Normal in early stages, may present with wheezing, crackles, or rhonchi, inspiratory stridor may indicate airway obstruction 8. Physical Appearance: Anxious, surface burns, singed facial hair, black soot marks, obvious pharyngeal swelling and edema, hoarseness, altered voice, dysphagia 9. Vital Signs: Increased HR, BP, Qt, pulse ox not accurate if CO poisoning present |
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Secondary Assessment - Thermal |
1. Chest X-ray: Normal in early stages, pulmonary edema/ARDS late stages 2. ABG: Acute alveolar hyperventilation with hypoxemia 3. PFT: Decreased volumes and flowrates, decreased DLco 4. Special Tests: COHb levels measured be co-oximeter |
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Treatment - Thermal |
1. Immediate assessment of patient's airway and respiratory and cardiovascular status (elective intubation should be performed for patients who have inhaled hot gases or demonstrate signs of impending upper airway obstruction) 2. Oxygen therapy at 100% 3. Hyperbaric oxygen therapy for CO poisoning 4. Evaluate depth and percent of burns 5. Immediate insertion of an IV line 6. Isolation room 7. Monitor ABG, electrolytes, and fluid levels 8. Monitor for signs of infection 9. Bronchoscopy to clear airways of mucus plugs and evaluation of upper airways 10. Mechanical ventilation for ventilatory failure 11. Pulmonary hygiene 12. Hyperinflation therapy 13. Aerosolized medications (bronchodilators, mucolytics, and anti-inflammatory agents) |
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Acute Respiratory Distress Syndrome (ARDS) |
An illness or injury to the lungs that results in reduced lung compliance and refractory hypoxemia. |
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Acute Respiratory Distress Syndrome (ARDS) |
An illness or injury to the lungs that results in reduced lung compliance and refractory hypoxemia. |
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Etiology - ARDS |
1. Aspiration 2. Trauma 3. Drug overdose 4. Fluid overload 5. Inhalation of toxins and irritants 6. Shock |
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Acute Respiratory Distress Syndrome (ARDS) |
An illness or injury to the lungs that results in reduced lung compliance and refractory hypoxemia. |
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Etiology - ARDS |
1. Aspiration 2. Trauma 3. Drug overdose 4. Fluid overload 5. Inhalation of toxins and irritants 6. Shock |
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Primary Assessment - ARDS |
1. Past History: Etiology 2. Cough: Non productive 3. Respiratory Pattern: Tachypnea, subs terms and/or intercostal retractions 4. Color: Cyanotic 5. Diagnostic Chest Percussion: Flat/dull note 6. Breath Sounds: Bronchial, crackles 7. Vital Signs: Tachycardia, hypertension |
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Secondary Assessment - ARDS |
1. Chest X-Ray: Diffuse alveolar infiltrates with a honeycomb or ground glass appearance, radiopacity 2. ABG: Refractory hypoxemia, acute alveolar hyperventilation with hypoxemia 3. PFT: Decreased volumes and capacities 4. Sputum: May indicate infection 5. Special Tests: Hemodynamic monitoring reveals elevated PAP with normal PCWP |
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Secondary Assessment - ARDS |
1. Chest X-Ray: Diffuse alveolar infiltrates with a honeycomb or ground glass appearance, radiopacity 2. ABG: Refractory hypoxemia, acute alveolar hyperventilation with hypoxemia 3. PFT: Decreased volumes and capacities 4. Sputum: May indicate infection 5. Special Tests: Hemodynamic monitoring reveals elevated PAP with normal PCWP |
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Treatment - ARDS |
1. Treat underlying cause 2. Oxygen therapy (increase FiO2 as high as 60%, then add CPAP/PEEP; when patient improves, titrate FiO2 to below 60%, then reduce CPAP/PEEP) 3. Closely monitor hemodynamics 4. Hyperinflation therapy for atelectasis 5. Implement ARDSNet ventilator protocol (reduce tidal volume to 6 ml/kg; maintain plateau pressure < 30 cm H2O; recruitment maneuvers) 6. Consider alternative modes of mechanical ventilation (IRV, APRV, PRVC, HFV, permissive hypercapnia, pulmonary vasodilator - iNO) 7. Consider prone positioning to improve oxygenation |
