Uploaded by Kennedy Geier

Note Mar 19, 2024

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Chest Trauma & Thoracic Injuries
contributeto75
ofalltraumaticdeaths
Twocategories
Penetratingtrauma
Blunttrauma
IBITEInternalinjury
Itmy
besevere
pneumothorax
Ardshemothoraxtensionpneumothorax
man
Nevertakeoutpenetratingobject
Carefulwithmovingpt
Common
Thoracicemergencies
Pneumothorax
Hemothorax
mothorax
Insistent
cardiactamponade
Effite
I if Spftp.ticompleteexam
new
Inspectairwaythoraxneck respiratoryeffort
Assessrespiratory cardiac neckveinsJVDabdomenhead
Elderly preexistingdisease
RibFracture mostcommonblunttrauma
cm
pain
shallowbreathing
atelectasis
Ip'smting
IntroprofCare
paincontrol NSAIDsfractures opioids brokenrib
Bindernolongerrecommended
incentivebreathingexercisesmimic
exercise
Preventatelectasisbycontrollingpainsopt.is
abletobreathdeeply
Flail chest fractureofconsecutiveribsin 2onmoreplaces
unstablesegment
Miachypnea
tachycardiadesat
movement ribspushinwhen
Asymmetricuncoordinatedthoracicmovementparadoxicalchest
theyshouldbepushedout
interpriffachspiration
ribspushoutduringexpiration
Airwaymanagement ventilation 02
Painmeds
surgicalrepair
Pneumothorax airenterspleuralcavityfroma penetratinginjurycollapsedlung
P
pantaneous toomuchair
it S
Is
acuteSobventilation
atheist
in
cmtrachealdeviation
cannot
but
escape
Hemothoraxblood
fillspleuralcavity
fluidfillspleuralcavity
chylothoraxlymph
cmof
nobreathsounds
Pneumothorax
volpressure
causesdamagetoalveolitoo
SpontaneousPneumothoraxsomething
muchaircandamagealveoliventilation COPD rupture
of
blebs airfilledblistersatapex
Blebsarecommonly
foundinyoungpatientsasaresult
oflungdiseaseCOPDasthmaCFpneumonia smokingincreases
riskofbleb
formation
blebstall thinmalegenderfamilyHxHx spontaneous
otherriskfactorsfor
of
IatrogenicPneumothoraxlacerationpuncture
duringtreatment
thoracicneedlepuncture leadingcause
Trans
bronchial
othercauses subclaviancathinsertionthoracentesispleural
biopsytrans
lungbiopsy
excessive
baro
mayleadto traumafrom
ventilatorypressure
unrelieved
betweensurrounding
pressure
cavity
caralungs
gas unvented
esophagealprocedures
trauma
maycausebaro
TensionPneumothorax airgoesintopleural
spacebutcannotescape
cm trachealdeviation
mayleadtoARDScmofARDS
universal
chokingsyndrome
tachycardia
p
Tx needledecompressionchest
tube
msn.IE
ia
ii
aesrace s
sn
Tx removefluid givebloodproducts
chylothoraxumph
fluidfillspleuralspaceduetoinflammatorycondition
cancerrelatedclogs
nodes
lymph
Txpleurexcath
Inter
profcareofPneumothorax
chestweocclusivepetroleumventeddressingclosedon3sidestoallowairtoescape
emergencycover
4sideddressingmaycausepneumothorax
insertion
drainage
chest
tube
needledecompression
magnes.mg
eseaiIwan
Adequateozventilation worstcase
scenarios
for
correcthypovalemia lowco
controlhemorrhage
givebloodproducts
vassopressors
questions
Neurologicalassessment orientation
Nobreathsounds pneumothorax
i giveozfirst
2prep
forchesttubeplacement
ofRespiratoryDistress
indications
RR 10on 30
slowbreathing brainnotbeingperfused
fastbreathingcompensatorymechanismforhypoxemia
soundsonabsent
breath
Adventegious
chest
pain
Dyspneaorthopnea
Accessorymuscleuse
Restlessnessagitationaltmental
status
cyanosis
inabilitytospeakinfullsentences useyesornoquestions
Chest Tubes & Pleural Drainage
HE.es sh gIfety espacewitubeplacedthroughribs
tubes20incheslongdiametermeasureinFrench iz20 trenon
diameter
in
small
trenchforair
Its
it
isplaced
tubeissuturedintoplaceweanocclusivedressing
insertion chesttube
of
Armonaffectedsideraisedaboveheadtoexposemidaxillaryarea
HOB3060
cleanseareawithantisepticsolution
anesthesialidocaine
Local
Providermakes
incision
overrib
small
advanced
chest
tube
upoverrib suturedinplace
placementconfirmed
byexr
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a
enIseisremovea
chestDrainageunits CDU 3basiccompartments
p
if
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p thischamber
drainedfluidstaysin1stcompartment airmovestosecond
compartment
2nd watersealchamber
Tithers
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suction
3rd
statin inwater
controlchamber
s
uction
Applies
tochestdrainagesystem
Two
types suctioncontrolwater dry
suctionregulatedbyamount H2O
suctionpressureusually 20amH2O
toinitiatesuctioningturn vaccumsourceuntilgentlebubblingispresent
of
of
up
visual
suctioningnowater
alertindicatessuctioning
Dry
PreparingCDU
overpt
Donot
crossunit tubes
i
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Tidaling waterrises fallswithinhalation exhalation normal
Assessvitalsigns lung
soundspain
Aseptic
techniquefordressingchanges
Encourage1B
Rom
watchout
for
Rapidremovalofpleural
fluid
subgEmphysemacracklingwhenpushingonchest
Bleeding
Atelectasis
I IIIentaldisconnectiondislodgement
ceased
Chesttuberemovaldonewhenlungreexpandedorfluiddrainageminimalorhas
Dieafter24hoursofnosuction
Provide
priortoDic
painmeds3060mins
Ptholdsbreathwhiletubeisbeingpulledout
occlusivepetroleumdressing on
put first24hoursis atightdressing
follow exrtomakesurelungs
remaininflated
up
Chest Surgeries
lungs
Thoracotomy dealingwithjust
median
borderofrib
sternotomyonlateralthoracotomyincisionalong
forlungdisorders
Posterolateral
I p.fii
monitor
isEnts a
p tm
n
CO2respiratoryrate pattern pain
on painmeds
VideoAssistedThorascopicSurgery VATS minimallyinvasivesurgicalapproachwithroboticsurgery
inspectbiopsyobtain
trauma
samplesremovetissuethoracic
multiplepunctureholes smallerwounds less
time
pain fasterhealing
needanesthesia
Advantages
pain Los amorbidityfewercomplications
Post
opexpectachesttubeambulateincentivespirometerpainmanagement
PerioperativeConsiderations
preop
testpet AbasEcg
Pulmonaryfunction
Entities.int
cardiacworkup
smokingcessation
Education
one
Iii iii it
give
Facilitateexpressions concernsfeelingsquestions
of
Postop
PainmanagementPCAnerveblocks
syndrome
watchoutforwhitecoat
Respiratoryassessment
incentivespirometer coughdeepbreathing
Pleural Effusion
PleuralEffusion abnormalcollectionoffluidinpleural
space notadisease indicatessomethingiswrong
Thireased
system
pulmonarycapillarypressurepushfluidfromcapillarysystemtolymph
decreased
oncoticpressure
increased
permeabilityfluid
pluralmembrane
fillsalveoli ARDS
obstruction lymphatic
causes
flowmajorinfectionthat obstruction empyema
of
cm diminisheddecreasedbreathsounds
Dyspnea
cough
faÉfÉfinformed TETIhurtsso
infection
breaths
shallow
feverfrom
Interpr
ofcare
treatunderlyingcause
nightsweatsweightlossifempyema
resort
onlyifhastobedonelast
Thoracentesis one done
monitorvs pulseox sisofrespiratory
distress
exrpostprocedure
chemical
pleurodesischemo
drugusedtodamagepleuralspace
Documentvolume color
cannotdraintoomuch
fluidatonetimetoavoidhypovolemicshock
1.22onlessat atime
removalofpleural
space last
resort
Atelectasis
Atelectasis collapsedairlessalveoli obstruction
Preventionambulationsittinguprightincentivespirometer
causedBy reducedventilationobstruction alveoli
of
Alveolartrapping
serfactantskeepalveoli
open
shallowbreathing noairflow
areaclosed trapbacteria pneumonia
abreathsoundsatbases atelectasis
airabsorbed
noadditionalairentersalveoli
pneumoniafever respiratorycomplications
alveolicollapses
Alt inbreathingpatterns
surgical
procedure
gygggyggm.gggggygggg
µ
decreasedlung
volume nodeep
breathing
impaired
coughgunk
staysinlungs
atidalvolume
pleural
effusionpleural
fluidpreventslungexpansion
pneumothoraxhemothorax
Tx antibiotics
Pneumonia
Pneumoniadefensemechanismsareincompetent acuteinfectionoflungparenchyma
broncho
constriction
coughreflex
Epiglottis
celator
Cilia mucoes
immunecells
mostlyfromviral bacterial
organismsreachlungsby
ff.fim
butgoesdownthewrongpipe
HematogenousspreadCAUDIblood
Tom
facilitywithin14daysof
munityaquirednecrotizingpneumoniaCAP personnothospitalizedorresidingin aLTC
7THSTsforoptnotesagevsmentalstatuscomorbiditiescurrentphysiologicalcondition
Necrotizingpneumonia akawalking
pneumonia rare
CURB65estimatesmortality CAP
of
Cconfusion v uremiaBun20 R RR30 B systolicBPaoordiastolic260 65 us1
Iliff.fifInYt.oraeabx
LDH 230 albumin 35 plateletcount400,000
Pneumonia HAPVAP common
MedicalCareAssociated
form
ofpneumonia reflectsnursingcare
HAPsymptoms
appear
48hoursafteradmissiontohospital
VAPventilatorassociatedPneumonia symptomsappearwithin48hoursofintubation
IncreaseLosincreased
dotsincreasedmorbidity mortality
as
fi f i
n
Loc
mafhi
as
lungs
intotraineal
mangets
frommonist
Head
injury
notube
Anesthesia
Difficulty
swallowing
makesureptknowshowtoswallowtoavoidaspirationtuckchin swallowtwiceHobelevated
iftheydon'tpassswallowtestptisNpo
Tx empiricabx
OpportunisticPneumonia inflammationinfectionoflowerrespiratory
tractinimmunocompromisedpatients
immune
s
ystems
impaired
factors
risk
rit
needs
nutrientstomake
immunodeficiencies Hivmalnutritionbody
immune
cells
immunosuppressive
therapyradiationchemotherapycorticosteroids
pneumonia
opportunistic
CMBcommonviral
PSPcommonbacterium
Patnoinfectiousagent
Ab
inalthoracicSx
65 yearsold
inflammation blocks exchangefluid
fillslungs
gas
Tx incentivespirometerambulationsplintingpainpreventsdeep
breathing
I IIIPc Yousness strokedrugor
Bedrestprolongedimmobility
Ffp
increasedaspirationrisk
thinkpositionofpatient
Fatsrabbits birds
carryvirusesthatcanspreadtohumans
immunosuppressivetherapy
inhalationaspiration somesubstancesthatare
toxictolungs
intestinalGIfeedings
d
own
sit
l
ungs
during
feedings
going
up
malnutritionbody
needsnutrientstomakeimmune
cells
of
recentabxtherapykillsoff
goodmicrobiomebacteria
LTCfacility
smokingdamagescilia
intubation may
leadtoVAP
upperRespiratoryinfection
cmofPneumonia
Eggs
skinclammy
maymovedownrespiratorysystem
aist.skpneaclosedalveoli
blueness
central headachelossofappetitemoodswingsconfusion
putptonsidewithleastfluidpneumonia
Pneumonia
of
Atelectasislackofairwayclosealveoli
Complications
Pleurisychest
painupondeepbreath
Pleuraleffusionfluidbuildupinpleuralcavitydiagnosewithexr Txchesttube
Bacteremiasepsis blood
culturegoalisnegativeblood
culture
inlungsdamagetoalveoli
blood
stream brainmay
lungs
causedeath
goto
Pneumothorax air
meningitis
ARE
Lungabscessesbacteriatrappedinlungs
Empyema acollection pus
of thatmayrupturediagnosisexrictTxsurgery
Diagnosis
Hx physicalexam
CxRmostcommon
Thoracentesis
forfluidONlungsnotinlungs
Bronchoscopywithwashingscommon
invasiveproceduretwilight
anesthesiabiopsy washing
sputumculture
B gicmarkersCRPinflammatorymarkers prolacitoninproducedtoaserumcalciumwheninfectionoccurs
InterpretCare
PREVENTION pneumococcalvaccine preunar13 pneumorax
20
Ispp
needles
ortherapyduetoimpairedgasexchange
breath
makesptcomfysotheycandeep
analgesics
antipyretics
coughsuppressants controversialsince
youwantpttocoughgiveatnight
bronchodilators
corticosteroids
mucolytics
r
Therapy
If fi iishie9fasx
therapy
Fluoroquinolones
Pomeds
PCN cephalosporins muchmorepotent
Zosinpenicillindrug choicedueto βlactaminhibitors
of
carbapenems
WPO
Hydration thinmucus
Foodhighincaloriesnutrients
smallfrequentmeals
9m hayeine
Acute Respiratory Failure
Developsover
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ig
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3CNSbrainstem
injurysciopioidOD
4Neuromuscular AlsGuillianBarresyndrome
schestwallpainobesityascitesbrokenrib
Hypoxemic RFwhenPace260 Fioz 60
anabolicmetabolism lacticacidosis
needofOz damagecapillaries
fluidleavescirculation hypotension fillsalveoli blocksgasexchange
vent
shuts
own
Yeh
shunt
perfusionmismatch VIQmismatch
antititiation
Hypercaphic buildup CO2 Paco 502 pH7.35
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If ghee
Apple
airway alveoliabnormalities
Cnsabnormalities
chestwallabnormalities
neuromuscularabnormalities
Pathophysiology
aseeinemiaiii.isiieeds
cmofRF
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smn
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Headache
Dyspnea
Airhunger
tachycardia
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Bradycardia bradypnea
centralcyanosis
Diaphoresis
Paradoxicalbreathing
Respiratoryarrest
BP
of
Consequences
Hypoxemia Hypoxia
metabolicacidosis
cardiovascular
CO
Permanentbraindamage
ImpairedrenalfunctionATN
GIsystemalterations
Diagnosticstudies
physicalassessment
c EE
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samepressureforinhalation exhalation
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usedforselectcases
in
Nitroglycerin vasodilates
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Acute Respiratory Distress Syndrome (ARDS)
aformofacuterespiratoryfailurewith ahighmortalityrate
suddenprogressive
formofARF
Alveolarcapillary
membranedamaged permeabletointravascular
fluid
Hypoxemia
refractorytosupplement02
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swelling
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lungremodeledbycollagenous fibrous
tissuescarring
alveoli
f
ibrosis
membraneremodeling
t
hickens
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capillary
Hypoxemia pulmonaryHTN
continue
conofARDS
Initialpresentationsubtle asymptomatic asmildrespiratorysis
AsARDSprogresses
color
Respiratorydistress ashen
workofbreathinghowhard
theyaretryingtobreath
Tachycardiadiaphoresischangeinmental
status
Tachypnea retractionsremove
gowntolookatchest
wall
anisffining
severehead
injury
shockedstates
sirsmobs
Profoundrespiratorydistressrequiringmechanicalventilation
it Ems int ceasingpicoline for
in
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increases
int sts i akaammatim
Renal
failure cobecauselessbloodcomingbacktoheartduetomachine pressurelowmap
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interpretmanagement
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Positionstrategies
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Nursingfluidbalance
PCWPnounwedgepressure6 10shows
impactofheartonlungs
Fluidrestrictiondiureticskeeppatientwarm dryvasodilatetopullfluidfromlungs heart
Nutritionalsupport nofeedingswhilepronemayneedTPN
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