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26 Cards in this Set
- Front
- Back
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Pulmonary contusion
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*bruise & swelling of the lung tissue
*"can't perfuse thru a bruise" *Tx: depends on severity & size *ranges from monitoring to full ventilatory support |
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Gun shot wound and stabs
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*check for entrance/exit wound
*goal: restore & maintain cardiac/pulmonary function *must eval quickly *tx: depends on injury |
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Chest trauma
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*responsible for up to 75% of trauma related deaths
*two types: -blunt -penetrating |
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Chest trauma is life threatening due to
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*hypoxemia (<breathing=<O2)
*hypovolemia (tachycardia, <LOC, SOB, <UO, cold/clammy) *cardiac failure (<SV--><CO) |
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Quick assessment skills for chest trauma
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*is pt. responsive and breathing?
*auscultate breath(fl/air, shallow breath, neuro inj) & heart sounds (tachycardia) *get a line in (IV) (NAVEL; NS, LR, Albumin) *how did it happen *when? * |
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Diagnostics for chest trauma
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*CXR (pneumo/hemothorax, lung prob, cardiomegaly, cardiac tamponade, rib fx)
*CBC (how much bleeding? H&H) *EKG (on 2 lead monitor; then 12 lead to look for cardiac injury) *ABG's (acidosis = cell death, hypoxia, impending resp failure) *clotting studies (can they stop bleeding) *type & cross (if blood needed right away) *electrolytes (<K=card. irrit.; <Na=seizures) *CT (chest, head) |
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Rib fractures
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*fx to 1-3rd rib have 15-30% mortality
*complications include: pneumothorax, lacerate SVC, puncture liver/spleen, fx treated conservatively-control pain |
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Flail Chest
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*40% mortality
*multiple rib fx causing free floating rib section and unstable chest wall *Paradoxical mvmt: in-inspir; out-expir *s/s: ^HR, ^RR, <BP, resp acid(signs of shock) *Tx depends on severity *severe-intubate and add PEEP |
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Cardiac Tamponade
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*compression of the heart from fluid in the pericardial sac (Medical emergency)
*s/s: depend on how quickly it comes on (<BP, distant heart sounds, pulsus paradoxus, SOB, tachypnea, anxiety, restlessness, ^HR, <CO) *surgical patients (open heart) at risk *Tx: pericardiocentisis or thoracotomy |
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Risk factors for PE
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*venous stasis
*hypercoagulation *venous disease *disease states *prevention is best |
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Subcutaneous Emphysema
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*"crepitus"
*air passage &/or lung injuries & air enters under skin *check around chest tubes & trachs too *usually harmless & self limiting (still document) *mark site & check if size increases |
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Aspiration
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*serious! can cause death
*vomit/food/drowning *usually happens when reflexes are lacking (unconscious, after prolonged intubation) *we cause them (tube feeds) |
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Therapeutic Interventions
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*quick assessment skills
*Remember ABCs *Tx and watch for hypoxemia, hypovolemia, and cardiac fail *know chest tubes & ventilators *explain what you are doing! *offer support to family |
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Types of shock related to trauma
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*hypovolemic-d/t vol of blood loss
*cardiogenic-d/t impairment of hearts ability to pump bl. *often in trauma, the person may experience both at once |
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ARDS (adult respiratory distress syndrome)
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diffuse interstitial edema all over lungs; looks like cotton candy (ventilate, PEEP)
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Pulmonary Embolus
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*obstr. of 1+ branches of pulm artery
*originate in venous system *most thrombus orig. in deep veins of legs *vent. without perfusion occurs |
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Clinical findings of PE
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*severe, sudden dyspnea
*extreme anxiety, restlessness *sharp pain in chest *fever *coughing with hemoptysis *on ausc: dullness over area of infarction |
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Diagnostic evaluation of PE
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*CXR
*EKG (r/o MI) *ABG's *VQ scan (vent/persion) *pulmonary angiography |
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Emergency Nursing Care of PE
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*high fowlers
*oxygen *start IV *relieve pain/anxiety *dissolve clot/prevent others from forming |
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Thrombolytic Therapy
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*urokinase/streptokinase
*high risk for bleeding *dissolves clot |
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Anticoagulation Therapy
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*Coumadin
*Heparin *If believe pt had PE - bolus them with heparin (to prevent other clots from forming), then start coumadin *PT levels affected by gr. leafy vegetables, antibiotics, and NPO status |
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Other therapies
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*pulmonary embolectomy
*vena cava filters (Greenfield filters) |
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Therapeutic Interventions of PE
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*Assess
*Nursing Diagnosis *Plan of care *Outcomes |
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Open pneumothorax
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*"sucking" chest wound
*inspiration air goes in *expiration air goes out *heart & vessels move back and forth *Tx: cover hole |
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Tension Pneumothorax
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*air goes in with inspiration
*air stays in with expiration *increased pressure (tension) *pushes lung, heart, trachea to oppisite side *Medical emergency!! *Tx: large bore needle 2ICS MCL |
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Hemo/Pneumothorax
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*goal-get rid of blood/air from pleural space
*s/s depend on severity: dyspnea to shock *Iatrogenic causes: line placement; surgery *dx on CXR *tx: chest tube |
