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Med/Surg Test 1
spc
| Question | Answer |
|---|---|
| A flail chest is the result of? | double fractures of at least three or more adjacent ribs, this causes the thoracic cage to become unstable |
| A flail chest causes a __________ lung disorder? | restrictive |
| A flail chest results in? | rib instability, lung volume restriction, atelectasis, lung collapse (pneumothorax), lung contusion, paradoxical movement, pendeluft |
| A blunt of crushing injury to the chest often cause a _______ chest? | flail ( MVA, Falls, compression by heavy object, etc....) |
| What is the current method of treating a flail chest? | mechanical ventilation with PEEP to stabilize the chest, allow healing and prevent atelectasis |
| Generally mechanical ventilation for ___ to ___ days is enough for adequate healing? | 5-10 |
| What are some signs of a flail chest? | Tachypnea, paradoxical movement, pendeluft causing hypoventilation, lung compression, atelectasis, decrased V/Q |
| Pendeluft is a shunting of gas from? | one lung to the other |
| You must have a _________ to diagnose flail chest? | chest x-ray |
| Thermal injury refers to injury caused by? | inhalation of hot gases |
| Thermal injuries are usually confined to the upper airway due too? | the ability of the upper airway to cool gases, reflex laryngospasm, and glottis closure |
| Bronchospasm does not usually occur with thermal injuries, the presence of __________ burns is usually a predictor of thermal injury. | facial burns, thermal injury may occur though with or without surface burns |
| Acute airway obstruction occurs in about 20-30% of thermal injury patients and is usually? | most marked in the supraglottic structures |
| Inhalation of steam at 100 C or greater results in? | severe damage at all levels of the respiratory tract |
| Direct thermal injuries do not usually occur in the distal airways unless caused by steam inhalation. Damage to the distal airways is caused by? | harmful products in the smoke that is inhaled, irritating and toxic gases, soot particles |
| The early stage of smoke inhalation injury (0-24 hours) ? | do not always appear right away but can result in bronchospasm, cough, wheezing, ARDS |
| The intermediate stage (2-5 days after) ? | upper airway thermal injury begins to improve, mucus production increases, distal lung injury continues to be a problem, mucosa becomes necrotic and sloughs leads to bacteria, bronchitis, and pneumonia |
| The late stage ( >5 days) ? | infections from wounds on body surface, can lead to sepsis and MODS, pneumonia |
| Hydrogen cyanide is a toxic substance and is found in? | polyurethanes |
| The higher percentage of body surface area that is burned equals? | more complications |
| The anterior and posterior chest make up the largest surface area that can be burned? | total 36% each are 18% |
| Physical signs of thermal injuries? | tachypnea, tachycardia, black sooty sputum (carbonaceous), normal breath sounds in early stage, wheezing, crackles, ronchi |
| CO has a greater affinity for hemoglobin, breathing CO at a partial pressure of <2 can result in a COHb of ? | >40% |
| A COHb level in excess of 20% is considered? | CO poisoning, a COHb level of >50% may cause irreversible damage (treat with hyperbaric if severe, or 100% 02) |
| Near drowning? | person survives a liquid submersion |
| Dry drowning? | the glottis spasms and prevents water from passing into the lungs, their lungs will be normal |
| Wet drowning? | the glottis relaxed and allows water to fill lungs, as fluid enters alveoli it begins the same pathological process as ARDS |
| Wet drowning? | laryngospasm, interstitial edema, decreased surfactant, apnea, cyanosis. crackles, rhonchi, wheezes, |
| What is the drowning sequence? | 1. Panic 2. calmness and apnea 3. swallowing water and vomiting 4. gasping and aspiration 5. convulsions 6. coma 7. death |
| What are favorable factors in surviving drowning? | cold water (colder the better), being young, less submersion time, no alcohol, cleaner water, less struggling, no serious injury, good CPR, non suicidal |
| Physical findings? | apnea, cyanosis, frothy sputum, radiograph can vary from normal to edema and atelectasis |
| Intubation and ventilation should be performed immediately if apnea is present? | also intubate if pt cannot maintain Pa02 of at least 60 on 50% |
Created by:
juialynn92
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