Glossary of Chest Trauma and Pulmonary Emboli

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Pulmonary contusion
*bruise & swelling of the lung tissue
*"can't perfuse thru a bruise"
*Tx: depends on severity & size
*ranges from monitoring to full ventilatory support
Gun shot wound and stabs
*check for entrance/exit wound
*goal: restore & maintain cardiac/pulmonary function
*must eval quickly
*tx: depends on injury
Chest trauma
*responsible for up to 75% of trauma related deaths
*two types:
Chest trauma is life threatening due to
*hypoxemia (<breathing=<O2)
*hypovolemia (tachycardia, <LOC, SOB, <UO, cold/clammy)
*cardiac failure (<SV--><CO)
Quick assessment skills for chest trauma
*is pt. responsive and breathing?
*auscultate breath(fl/air, shallow breath, neuro inj) & heart sounds (tachycardia)
*get a line in (IV) (NAVEL; NS, LR, Albumin)
*how did it happen
Diagnostics for chest trauma
*CXR (pneumo/hemothorax, lung prob, cardiomegaly, cardiac tamponade, rib fx)
*CBC (how much bleeding? H&H)
*EKG (on 2 lead monitor; then 12 lead to look for cardiac injury)
*ABG's (acidosis = cell death, hypoxia, impending resp failure)
*clotting studies (can they stop bleeding)
*type & cross (if blood needed right away)
*electrolytes (<K=card. irrit.; <Na=seizures)
*CT (chest, head)
Rib fractures
*fx to 1-3rd rib have 15-30% mortality
*complications include: pneumothorax, lacerate SVC, puncture liver/spleen, fx treated conservatively-control pain
Flail Chest
*40% mortality
*multiple rib fx causing free floating rib section and unstable chest wall
*Paradoxical mvmt: in-inspir; out-expir
*s/s: ^HR, ^RR, <BP, resp acid(signs of shock)
*Tx depends on severity
*severe-intubate and add PEEP
Cardiac Tamponade
*compression of the heart from fluid in the pericardial sac (Medical emergency)
*s/s: depend on how quickly it comes on (<BP, distant heart sounds, pulsus paradoxus, SOB, tachypnea, anxiety, restlessness, ^HR, <CO)
*surgical patients (open heart) at risk
*Tx: pericardiocentisis or thoracotomy
Risk factors for PE
*venous stasis
*venous disease
*disease states
*prevention is best
Subcutaneous Emphysema
*air passage &/or lung injuries & air enters under skin
*check around chest tubes & trachs too
*usually harmless & self limiting (still document)
*mark site & check if size increases
*serious! can cause death
*usually happens when reflexes are lacking (unconscious, after prolonged intubation)
*we cause them (tube feeds)
Therapeutic Interventions
*quick assessment skills
*Remember ABCs
*Tx and watch for hypoxemia, hypovolemia, and cardiac fail
*know chest tubes & ventilators
*explain what you are doing!
*offer support to family
Types of shock related to trauma
*hypovolemic-d/t vol of blood loss
*cardiogenic-d/t impairment of hearts ability to pump bl.
*often in trauma, the person may experience both at once
ARDS (adult respiratory distress syndrome)
diffuse interstitial edema all over lungs; looks like cotton candy (ventilate, PEEP)
Pulmonary Embolus
*obstr. of 1+ branches of pulm artery
*originate in venous system
*most thrombus orig. in deep veins of legs
*vent. without perfusion occurs
Clinical findings of PE
*severe, sudden dyspnea
*extreme anxiety, restlessness
*sharp pain in chest
*coughing with hemoptysis
*on ausc: dullness over area of infarction
Diagnostic evaluation of PE
*EKG (r/o MI)
*VQ scan (vent/persion)
*pulmonary angiography
Emergency Nursing Care of PE
*high fowlers
*start IV
*relieve pain/anxiety
*dissolve clot/prevent others from forming
Thrombolytic Therapy
*high risk for bleeding
*dissolves clot
Anticoagulation Therapy
*If believe pt had PE - bolus them with heparin (to prevent other clots from forming), then start coumadin
*PT levels affected by gr. leafy vegetables, antibiotics, and NPO status
Other therapies
*pulmonary embolectomy
*vena cava filters (Greenfield filters)
Therapeutic Interventions of PE
*Nursing Diagnosis
*Plan of care
Open pneumothorax
*"sucking" chest wound
*inspiration air goes in
*expiration air goes out
*heart & vessels move back and forth
*Tx: cover hole
Tension Pneumothorax
*air goes in with inspiration
*air stays in with expiration
*increased pressure (tension)
*pushes lung, heart, trachea to oppisite side
*Medical emergency!!
*Tx: large bore needle 2ICS MCL
*goal-get rid of blood/air from pleural space
*s/s depend on severity: dyspnea to shock
*Iatrogenic causes: line placement; surgery
*dx on CXR
*tx: chest tube

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