Injuries
Chest Trauma and Thoracic
Emergency Management
Chest Trauma
·assess for
of respiratory distress and
signs
cardiovascular compromise
initial interventions
ongoing monitoring
·
potential intubation
Se
Fractured Ribs
caused by blunt trauma
ribs s-a most common blc least
pain w/inspiration
:
splinting
↳
:
2 or more places or fractured
Sternum and
several consecutive ribs
unstable chest wall
ensure adequate
my paradoxical movement
-
oxygenation and
ventilation
·
rapidshallow
inadequate ventilation
crepitus
intubation, mechanical vent orl
surgical
fixation
may be
breathing
splinting
pain management
fluid replacement
(possible
nerve blocks
and use of
3 or more consecutive fractured ribs
distress
,
pneumonia
breathing coughing , using spirometer
Flail Chest
respitory
atelectasis
and
pain w/NSAIDs , opiods
teach pt about deep
needed
by chest
muscle
coughing
shallow respirations
reduce
protected
heard around broken ribs
analgesics
Pneumothorax
air enters into the
the
long
pleural cavity
small
dyspnea
mild
*
·
tachycardia
Spontaneous Pneumothorax
rupture of blebs formed
healthy
on
,
,
Tension Pneumothorax
Pneumothorax
MEDICAL EMERGENCY !!!
resp and cardio compromised
puncture of lung during a
lungs
smokers/fall thin males / family ux
(vent dressing) administer Oz
prepare for CT insertion
Latrogenic
individuals (COPD asthmal
or sick
large
respiratory distress
absent breath sounds over
the affected area
cover the wound on 3 sides
and
collapsing
due to positive pressure
and
ux of spont Pt are risk
medical procedure
(lungpiopsies and needlel
airtrapped
aspirations
.
pressure
w/
tachycardia, severe dyspnea
·
CT
tracheal deviation
Chylothorax
decreated/absent
lymphatic fluid in pleural space
use CT a
may
Chest Tube
respiratory
·
provide suplemental Oz
·Keep CT belowpt chest
monitor for air leaks
encourage
deep
breathing
prevent 100ps/ kinks intubing
,
spirometer and ROM exercises
assess
BS over affected side
vein distention
and
aiaphoresis
needle aspiration and CT ar
pt can die duetr inadequate CO
pain management
avainage
neck
cyanosis
Management
HOB 30 degrees
assess
·
administer Octereotide
assessment
compress
greater vessels
b cardiac output
pleural cavity
treat
in pleural space carse
increase and
heart and
Hemothorax/Hemophermothorax
blood in
to
dressing around
T insection
Chest
VATS Procedure
Thoracotomy
incision in the chest wall to
bleeding or injured tissues
Thorocentesis
aspiration
minimal yinvasive meeta
·
look for
needs a CT
surgeries
and
right after ! I
fluids for
manipulate instruments
plerval space
treatment
in
anterolateral/axillary/posterolateral · less
discomfort/reduced hospital stay/
lower mobidity fewer complications
/
:
Pre OP
assess
cardioprimonary
diagnostic studies (X-ray CBC cong studies)
,
pt
hypotension ,
edema may occur
assess resp status
:
,
my rapid aspiration of
large fivids !
Ou
pain management
hypoxia
and reexpansion of
get chest
X-ray
to rule
Pneumothorax
PCA , epidural, nerve block
(RR effort
BS, sputum etc
,
,
·
monitor for infection
ahasthesia consult
smoking
us
En
.
status
,
living
retur to normal
post Op
vs
.
faster to
of intrapleural
diagnosis and
(temp dressing)
,
cessation
teaching /pain management splinting I
,
,
blood admin , CT
Restrictive Resp
.
Disorders
I
L
Atelectasis
inflammed
collapsed lung blo secretions
Obstructing
decreased BS
the
percussion
bedridden , post op abdominals
Chest
surgerpt
at
risk
deep breathing, spirometer,
early ambulation
pleura
and
boncotic pressure
Sharp pain , shallow
breathing
sfriction rub on inspiratory
underlying
lung
↑ pulmonary capillary pressure
trauma etc)
treat
Pleural Effusion
abnormal amount of fluid in
Ifrom cancer, infection, chest
airway
and dull
I
pleurisy
cause
,
peak
I pleural membrane
lymph
permeability
flow obstruction
antibiotics /
drainage
Interstitial
Lung
Diseases
I
Idiopathic Pulmonary Disease /S year survival
(30-50%) I
Chronic progressive disease where
connective tissue
is
scarred/inflammed
exertional dyspnea
·dry non
Clubbing
productive cough
~ne diagnostic
:
PFT
:
b vital
CUACKICS
Conicosteroids, Oz , pulmonary rehab,
kinase inhibitor,
or
lung transplant
VATS
capacity and
impaired gas exchange
***
golden
standard