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Cardiothoracic Traum

N202 Test 3

TermDefinition
What is the mindset that you should have when working with a patient with cardiothoracic trauma? Suspect the worst, hope for the best.
What percentage of chest trauma patients die before reaching the ER? 50%
How often are pure chest injuries seen? Rarely.
What type of injury is suspected when it's located at the 4th-10th intercostal space (ICS)? Lung or cardiac.
What does ICS stand for? Intercostal Space.
What type of injury is suspected when it's located at the left 9th-11th intercostal spcae (ICS)? Spleen.
What type of injury is suspected when it's located at the right 5th-10th intercostal (ICS) space? Liver.
What are the two main types of causes of cardiothoracic trauma? 1. Blunt 2. Penetrating
What are some types of blunt causes of cardiothoracic trauma? 1. Falls 2. Motor Vehicle Accidents (MVA) 3.Coming into contact with certain objects (bike handle bars, baseball bat, and steering wheels).
What are the two categories of MVA causes of cardiothoracic trauma? 1. Acceleration 2. Deceleration
What is an example of a blunt trauma that can occur due to acceleration? Rear end collision.
What is an example of a blunt trauma that can occur due to decleration? Head on collision.
What occurs during deceleration? Even though the vehicle has stopped, your organs continue to move, causing shearing.
What are penetrating causes of cardiothoracic injury? 1. Stabbing/knife wounds 2. Gun shot wounds 3. Impaled objects
What does GSW stand for? Gun shot wounds.
What do gun shot sounds cause? Direct organ damage.
What do gun shot wounds more likely to require? Surgery.
In regards to a knife wound, what type of action causes more damage? Rocking.
In regards to a knife wound, what should you look for? A bruise.
When someone suffers a knife wound, what should you do? 1. Collect the evidence 2. Retain the weapon
What type of velocity are knife wounds? Low velocity
In what direction do women stab? Down
In what direction do men stab? Up
What are gun shot wounds always considered to be? Contaminated
What should you look for in gun shot wound victims? Entrance and exit sites.
What are the type of bullets in gun shot wounds? There are a variety of bullets.
What size cavity can be created by some bullets in gun shot wounds? Some bullets can create a cavity 30-40 times larger than the bullet.
What do impaled objects create? A mechanical tamponade.
Should you remove an impaled object? No; impaled objects create a mechanical tamponade.
What should you do for a patient with an impaled object? Immobilize the instrument (impaled object) so it does not move and cause more damage.
What may surround the entry site in a gun shot wound? Powder burns.
What are the components of the primary survey you will complete with cardiothoracic trauma? 1. Airway 2. Breathing and Oxygenation 3. Circulation 4. Rapid Assessment
What are the components of the secondary survey you will complete with cardiothoracic trauma? 1. Mechanism of Injury 2. Health History
What is the purpose of the primary survey? To rapidly identify survival issues (ABCDE).
In order to maintain an airway, what may a client need? A tracheostomy or cricothyrotomy.
What should be stabilized in regards to the client's airway? The C-spine.
What should you watch for when assessing breathing and oxygenation? 1. Respiratory symmetry 2. Change in level of consciousness (LOC) 3. Hypoxia
How many large bore needles are placed in a client? 2 large bore catheters (16-18 gauge).
Where are the IV lines placed in a client with cardiothoracic trauma? Antecubitals.
What types of fluids are given to someone with cardiothoracic trauma? NS or LR
What does NS stand for? Normal Saline
What does LR stand for? Lactated Ringers.
How long does a cross match for blood take? 1 hour.
What should you monitor urine output for? Urine output > 30 cc/hour
What conditions are you assessing for in the rapid assessment? 1. Pneumothorax 2. Hemothorax 3. Cardiac Tamponade 4. Flail Chest
What should you do when assessing the chest? Expose it so you can visualize it.
What should you inspect the chest for? 1. Intercostal and Subclavian Retractions 2. Bruising
What type of retractions should you inspect the chest for? Intercostal and Subclavian retractions.
What does ABCDE stand for? A=Airway B=Breathing C=Circulation D=Disability E=Exposure
What should you do to assess the client for disability? Complete a rapid neuro evaluation.
When assessing the patient and undressing them, what should you be sure to do? Keep them warm.
When palpating the trachea, what should you assess for? Tracheal deviation.
Aside from palpating the trachea, what else should you palpate for? 1. Rib crunching 2. Subcutaneous emphysema.
What diseases will affect treatment of cardiothoracic trauma and the outcomes associated with it? 1. Chronic respiratory disease 2. Cardiac disease 3. Renal disease
There is a poor outcome when base excess is high or low? High
What does the base excess determine? The severity of acidosis.
What is a pulmonary contusion? A bruise to the lung.
How do pulmonary contusions occur? When the lung hits the rib cage; usually from blunt trauma.
What is the most common chest injury? Pulmonary contusion.
What are pulmonary contusions most commonly caused by? Blunt trauma.
What do pulmonary contusions cause to happen to the lung? The pulmonary capillaries rupture, causing interstitial hemorrhage, edema, and hemoptysis several hours after injury.
What does a pulmonary contusion cause? A dilution of surfactant which decreases lung compliance.
What effect does decreased lung compliance have? The lungs don't respond well to oxygen.
What is hemoptysis? Coughing up blood.
What are the signs and symptoms of pulmonary contusions? 1. Asymptomatic at first 2. Chest pain 3. SOB 4. Hemoptysis 5. Decreased breath sounds 6. Crackles
What is the initial sign and/or symptom of pulmonary contusion? Asymptomatic at first.
What are the complications of a pulmonary contusion? 1. Atelectasis 2. Pneumonia 3. Hypoxia 4. Respiratory arrest
What is the treatment of a pulmonary contusion? 1. Oxygen 2. Mechanical ventilation 3. PEEP 4. Pain control 5. Medications
What specific classes of medications would be given for a pulmonary contusion? 1. Diuretics 2. Glucocorticoids
What develops over time in a pulmonary contusion? Respiratory failure
How long after the trauma does respiratory failure occur with a pulmonary contusion? Several hours (6-12 hours later)
How long does a pulmonary contusion to present on a chest x-ray? As a hazy opacity.
How long after trauma will a pulmonary contusion show up on an x-ray? 6-12 hours later.
When is it best to check ABG results with a pulmonary contusion? It is best to check ABG results early.
What will ABG results first show in a patient with a pulmonary contusion? Hypoxemia
What are the signs and symptoms of a rib fracture? 1. Bruising over the rib(s) 2. Pain with inspiration 3. Crepitus on palpation
How are rib fractures diagnosed? By chest x-ray
What should you watch for with rib fractures? 1. Pneumothorax 2. Pulmonary contusion
What is the treatment for rib fractures? 1. Pain control 2. Voldyne
What should you avoid doing with rib fractures? No splinting or taping
What is the most commonly seen chest wall injury? Rib fractures.
Which ribs are usually fractured? Ribs 5-9.
What population can rib fractures be deadly in? The elderly with already poor lung compliance.
What is the usual cause of rib fractures? A blunt force that fractures the bone and drives the end into the thorax.
What are some examples of blunt trauma that can cause rib fractures? 1. Steering wheels 2. Falls 3. Baseball bats 4. Contact sports
What is the first rib associated with? The clavicle and scapula.
What can a fracture of the 1st rib perforate and cause damage to? 1. Aorta 2. Great vessels 3. Subclavian artery 4. Tracheobrachial injury.
What does perforation from rib fractures cause? Increased mortality
What should you watch for with fractures of the lower ribs? Liver or spleen injury.
What is another name for the Voldyne? Incentive Spirometer
Why should you not splint fractured ribs? Splinting impairs ventilation.
What type of clothing should someone with fractured ribs wear? Loose, non constrictive clothing.
Fractured ribs will unite spontaneously in how many weeks? 6 weeks.
What is the number one thing you'd do to treat fractured ribs? Control pain.
What is the number two thing you'd do to treat fractured ribs? Maintain ventilation.
How does someone with fractured ribs usually breathe? Shallow
Why does someone with fractured ribs breathe shallow? Due to pain.
Is coughing painful with fractured ribs? Yes
What should be encouraged with fractured ribs? Voldyne use (incentive spirometer)
In regards to ice and heat, when should you apply each for the treatment of fractured ribs? Ice for the first 24 hours and then apply heat.
How long should ice be applied for rib fractures? For the first 24 hours and then apply heat.
What type of pain management us used for rib fractures? Local anesthetics or nerve blocks into the intercostal nerves; low dose narcotics are used.
What is flail chest? Segmental rib fractures of multiple ribs.
How does the panel move in flail chest? The panel moves in with inspiration and out with expiration.
What does flail chest cause? Disrupted mechanism of breathing.
What are the radiographic signs of flail chest? 1. Segmental rib fractures of multiple ribs 2. The panel moves in with inspiration and out with expiration 3.Other evidence of thoracic trauma
What is an example of an injury that would result in flail chest? Being hit in the ribs with a baseball bat where a piece of all of the ribs breaks off due to the force of the trauma.
What are the signs and symptoms of flail chest? 1. Chest wall moves inward with inspiration 2. Chest wall moves outward with expiration 3. SOB 4. Pain
How is flail chest diagnosed? 1. CXR 2. ABGs *(CXR and ABGs are most common) 3. CT 4. ET
What should you watch for in flail chest? 1. Pneumothorax 2. Pulmonary Contusion
What is the treatment for flail chest? 1. Externally stabilize the flail 2. Oxygen 3. Mechanical ventilation 4. PEEP 5. Pain control 6. May need surgery to repair it
What does the client experience in flail chest that is secondary to multiple rib fractures? Paradoxical respiration
Is there negative or positive pressure with inspiration in cases of flail chest? Negative pressure
When occurs when there is negative pressure with inspiration with flail chest? The flail segment moves in which leads to ineffective ventilation.
Flail chest is easier to see from what view? Anterior
Why is flail chest easier to see anteriorly? Due to the lack of back muscles.
After what event might you see flail chest? CPR; due to costochondral junction breaks.
Why might you see flail chest after CPR? Due to costochondral junction breaks.
How should you externally stabilize the flail in a patient with flail chest? With tape, sandbags, or pillows.
What is the preferred method of stabilization in flail chest? Pillows
What should you never do to a patient with flail chest? No splinting
Why should you never splint a patient with flail chest? It impairs ventilation
In what position should you place a client with flail chest? 1. Semi-Fowlers 2. On their injured side
What is a client with flail chest intubated with? PEEP
What types of pain control is provided for a client with flail chest? 1. Morphine Sulfate IV 2. Intercostal nerve blocks
What underlying issue should you assess a client with flail chest for? Contusion(s)
What is a pneumothorax? Air in the pleural space.
What are the two types of pneumothorax? 1. Open 2. Closed
What is another name for an open pneumothorax? Sucking chest wound
What is another name for a closed pneumothorax? Spontaneous
What is the pleural space usually? A vacuum tight seal.
What is an open pneumothorax? There is free communication with the pleural space and the atmosphere; air enters the chest wall with inspiration and air exits the chest wall with expiration.
What is the cause of an open pneumothorax? Penetrating trauma; usually explosions or gun fire, but are not stab wounds.
What is a type of penetrating trauma that cannot cause pneumothorax? Stab wounds.
Why are stab wounds not a cause of open pneumothorax? Because stab wounds are similar to pulling out a chest tube.
What will you hear with a pneumothorax? You will hear a suck on inspiration as air rushes into the negative pressure in the pleural space.
Why will you hear a suck on inspiration with a pneumothorax? Because air rushes into the negative pressure in the pleural space on inspiration.
In what population do spontaneous pneumothorax occur? People in their 20's.
What is the cause of spontaneous pneumothorax in people in their 20's? There us no known reason.
What can cause a closed pneumothorax? 1. Disease 2. Mechanical ventilator
If there is an open wound relating to a pneumothorax, what should you do? Cover the wound.
What occurs with a sucking chest wound? Air is leaked outside the lung and the lung becomes compressed by the pneumothorax, causing the trachea to deviate back and forth while breathing and the organs shift to the unaffected side.
What are the signs and symptoms of pneumothorax? 1. Asymmetrical lung expansion 2. Decreased or absent breath sounds on the affected side 3. Tracheal deviation toward the unaffected side 4. Hyperresonance w/percussion on the affected side 5. Dyspnea 6.Tachypnea 7. Subcutaneous emphysema 8. Chest Pain
What is the treatment for pneumothorax? 1. Sterile dressing taped on 3 sides only 2. Chest tube 3. Surgery
How many sides of the dressing should you tape in cases of a pneumothorax? 3
In a closed pneumothorax, what side will the trachea deviate to? The trachea will deviate away from the affected side.
What is Hamman's Crunch? A crunching sound that is heard with each breath in pneumothorax; due to mediastinal air accumulation.
What is the cause of Hamman's Crunch? Mediastinal air accumulation.
Is there time for diagnostic tests with a pneumothorax? No
What diagnostic tests would you complete if there were time in a pneumothroax? 1. CXR 2. ABGs
Why will you only tape 3 sides of the dressing of a chest tube in a pneumothorax? The one open side acts as a valve so air can escape; mimics a flutter type valve effect.
If a patient with a sucking chest wound's condition worsens once you place a dressing on it, what should you do? Immediately remove the dressing.
What can subcutaneous emphysema at the neck area cause? A change in voice. The voice will dissipate.
What change will subcutaneous emphysema at the neck area make to the voice? The voice will dissipate.
What does subcutaneous emphysema result from? Air leaking from the pleural space into the skin tissue.
Should you let the physician know about subcutaneous emphysema? Yes
Where is the chest tube placed on a patient with a pneumothorax? The end of the tube is placed near the apex of the lung; 5th ICS, MCL.
What does ICS stand for? Intercostal space (ICS)
What does MCL stand for? Mid Clavicular Line (MCL)
What does CT stand for? Chest tube
Where is the chest tube placed in pneumothorax? High.
If a chest tube is placed for a pneumothorax, will you get a lot of fluid draining? No; it will be mostly air.
At what rate of drainage from a chest tube would you contact the physician? >150 cc/hour
What is a tension pneumothorax? A rapid and life threatening illness in which air enters on inspiration but does not leave on expiration, causing a fatal increase in intrathoracic pressure.
What cause the increased intrathoracic pressure in tension pneumothorax cause? Hemodynamic compromise due to compression of the heart and great vessels.
What are the causes of tension pneumothorax? 1)Mediastinal shift 2)Tracheal deviation toward the unaffected side 3)Hyperresonance or tympany on affected side 4)Decreased or absent breath sounds on the affected side 5)Decreased heart sounds 6)SubQtaneous emphysema 7)Tachypnea 8)Dyspnea 9)JVD
What are the signs and symptoms of a tension pneumothorax? 1)Mediastinal shift 2)Tracheal deviation toward unaffected side 3)Hyperresonance or tympany on the affected side 4)Decreased or absent breath sounds on the affected side 5)Decreased heart sounds 6)Subcutaneous emphysema 7)Tachypnea 8)Dyspnea 9)JVD
What does JVD stand for? Jugular venous distention
What is the treatment for a tension pneumothorax? 1. Emergency needle decompression 2. Chest tube 3. Oxygen 4. Pain control 5. Deep breathing 6. Tissue culture
What occurs in a mediastinal shift? The trachea, aortic knob, and right heart border shift.
How soon much you treat a tension pneumothorax? Right away.
What are the diagnostic tests performed for a tension pneumothorax? There is no time to complete diagnostic tests; if there were, however, it would be CXR and ABGs.
What is the priority with a tension pneumothorax? To relieve the air pressure.
What size needle is used for emergency needle decompression? 14-16 gauge
At what location is the needle inserted for emergency needle decompression? 2nd ICS MCL
What is the nurse's role in the treatment of a tension pneumothorax? Prepare the chest tube for quick insertion.
What is the main needle type used for emergency needle decompression? 1. McSwain Dart and Flutter Valve
What is the purpose for a needle thoroctomy? To convert a tension pneumothorax to an open pneumothorax.
Where is the chest tube placed for an open pneumothorax? 5th ICS MCL
After the chest tube is placed, what should you instruct the client to do? Change position and complete should ROM exercise to prevent contractures.
How does McSwain's dart and the flutter valve work? McSwain's dart has a trochar for insertion which is removed. Flutter valve is attached to the McSwain's dart which allows air to escape during exhalation. The valve's rubber diaphragm collapses on inhalation preventing air from entering the pleural space
What does the finger cot at the end of the McSwain's dart and flutter have on the end of it? A cut which collapses on inhalation to prevent air from entering the plural space.
What is a simple procedure that can rapidly evacuate trapped air until a chest tube can be inserted? Needle decompression.
What is a hemothorax? Blood in the pleural space.
What are the overall signs and symptoms of a hemothorax? 1. Cyanosis 2. Flattened neck veins 3. Respiratory difficulty (late symptom) 4. Absent breath sounds 5. Percussion over lungs is dull and/or flat 6. Low BP 7. Shock
How much blood is in the pleural space in mild hemothorax? < 350 cc
How much blood is in the pleural space in moderate hemothorax? 350-1500 cc
How much blood is in the pleural space in severe hemothorax? > 1500 cc
What are the signs and sympoms of mild hemothorax? No signs and symptoms are present
What are the signs and symptoms of moderate hemothorax? 1. Decreased breath sounds 2. Dull to percussion 3. Dyspnea 4. Decreased pulse ox 5. Chest pain
What are the signs and symptoms of severe hemothorax? 1. Massive blood loss 2. Tracheal deviation 3. Shock 4. Hypovolemia 5. Severe respiratory distress
Is the CXR normal or abnormal in mild hemothorax? Normal
What is present in the thorocentesis with mild hemothorax? Blood.
What is hemothorax often associated with? Pneumothorax.
What causes hemothorax? Hemothorax is caused by an injury to pleural vessels and intercostal vessels.
What does the bleeding often stop in hemothorax? After the lung is re-expanded.
Hemothorax is often associated with pneumothorax because there is decreased ventilation that is secondary to what? Compression affecting lung compliance.
What is the treatment for hemothorax? 1. Chest tube 2. IV fluids 3. Blood transfusions/autotransfusion 4. Oxygenation 5. Mechanical ventilation 6. Surgical thorocotomy repair
When is emergency surgery considered for hemothorax treatment? If there is arterial damage, 2000 cc of blood, or continuous chest tube bleeding.
How long is O negative blood given in cardiothoracic trauma? 15-20 minutes
Created by: ah070