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Chest trauma MS2
| Question | Answer |
|---|---|
| Chest trauma emergency management | O2 to keep SpO2 above 90%, 2 large bored catheters and begin fluid resuscitation, remove clothing to assess injury, stabilize impaled objects, semi-fowlers, admin analgesia, prepare for needle decompression, treat sucking chest wounds as needed |
| Fractured ribs manifestations | Pain with inspiration and coughing, splinting, shallow respirations |
| Fractured ribs complications | Atelectasis and pneumonia |
| Fractured ribs treatment | Reduce pain: NSAIDs, opioids, nerve blocks |
| Flail chest manifestations | Rapid shallow respirations, asymmetric movement, inadequate ventilation, splinting, crepitus near fractures |
| Flail chest and Pneumothorax diagnosis | Chest x-ray |
| Flail chest treatment | Intubation (if unstable), prevention of pneumonia, analgesics |
| Pneumothorax manifestations | Small - mild tachycardia, dyspnea. Large - respiratory distress, absent breath sounds over affected area. |
| Spontaneous pneumothorax | Rupture of blebs. Risk if tall, thin, male, family history, previous spontaneous pneumothorax, mechanical vent. Blebs rejected thorascopically under general a thesis. 1-3 days in hospital |
| Iatrogenic pneumothorax | Medical procedures. Open heart surgery, thoracic surgery, placement of subclavian central lines |
| Tension pneumothorax manifestations | Cyanosis, air hunger, shortness of breath, agitation, tracheal deviation AWAY from affected side, subcutaneous emphysema, neck vein distention, hyperresonance to percussion (drum sound) |
| Needle thoracentesis | Temporary tension pneumothorax intervention. 12 - 14 gauge catheter placed into 2nd-3rd intercostal space in midclavicular line. Will not re-expand lung. Prepare for tube thoracostomy (chest tube) |
| Open pneumothorax management | Cover wound with 3 sided occlusive dressing. If impaled object in place = stabilize w/ bulky dressing |
| Chest tube insertion | Client has affected arm raised above head OR leaning over bedside table. Drain air = place upward, drain fluid = place lower |
| Pleural drainage compartments | 1 = collection. 2 = water-seal chamber (continuous bubbling means leak, no tidaling means occlusion). 3 = suction chamber |
| Flutter or Heimlich valve | For small pneumothorax. Patients can go home with it. |
| Chest drainage management | Keep below chest, report greater than 200mL/hr in first hour and 70 mL/hr thereafter, report sudden change in drainage (cloudy, bloody). If breakage or disconnection then place tube in 2 cm of sterile water and then replace |
| Clamping chest tubes | Not during transport. Only when changing drainage unit or checking for leaks |
| Removal of chest tube | When lungs re-expanded and drainage is minimal. Pre-medicate, valsalva maneuver during removal (pinch nose, close mouth, blow out air), apply occlusive dressing, chest x-ray |
| Criteria for calling rapid response | Any unexplained decrease in LOC, new agitation or delirium, prolonged seizures, acute neurological changes, signs of sepsis. NOT used in emergency room |
Created by:
Haydenmeh
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