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Med/Surg Test 1


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