T3: Chest Trauma

Question 1

blunt trauma

Answer 1

*occurs when the chest strikes or is struck by an object

Question 2

Penetrating trauma

Answer 2

is an injury in which a foreign object impales or passes through the body tissues, creating an open wound

Question 3

treatment options for chest trauma

Answer 3

depends on severity; may resolve spontaneously
*Thoracentesis
*Chest tubes
*Pleurodesis

Question 4

thoracentesis

Answer 4

surgical puncture to remove fluid from the pleural space

Question 5

Pleurodesis

Answer 5

creation of adhesions between the parietal and visceral pleura to treat recurrent pneumothorax

Question 6

most common rib fracture

Answer 6

5-9

Question 7

clinical manifestations of rib fractures

Answer 7

*Pain
*Splinting
*Shallow respirations

Question 8

What can rib fractures lead to?

Answer 8

atelectasis and pneumonia

Question 9

treatment for rib fracture

Answer 9

*NO strapping or binding chest
*NSAIDs, opioids, nerve blocks

Question 10

patient teaching for rib fracture

Answer 10

*Deep breathing and coughing
*Incentive spirometry
*Appropriate use of anaglesics

Question 11

flail chest

Answer 11

fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment

Question 12

clinica manifestations of flail chest

Answer 12

-movement of thorax is asymetric and uncoordinated (moves air poorly)
-rapid shallow breaths
-tachycardia
-chest splinting

Question 13

diagnosis of flail chest

Answer 13

-Observation of abnormal thoracic cavity movements
-palpitation for crepitus near the rib fractures
-chest x-ray

Question 14

management of flail chest

Answer 14

*Adequate airway and ventilation
*Oxygen therapy
*Analgesia
*Surgical fixation

Question 15

signs of respiratory distress

Answer 15

*Dyspnea
*Cough with or without hemoptysis
*Cyanosis
*Tracheal deviation
*Decreased breath sounds
*Decreased O2 saturation
*Frothy secretions

Question 16

signs of cardiovascular compromise

Answer 16

*Rapid, thready pulse
*Decreased BP with narrowed pulse pressure and/or asymmetric readings
*Distended neck veins
*Muffled heart sounds
*Chest pain
*Dysrhythmias

Question 17

Initial interventions for any patient with chest trauma include

Answer 17

*Circulation, airway, breathing
*Administer O2
*Establish IV access with 2 large-bore catheters and begin fluid resuscitation as appropriate
*Remove clothing to assess injury
*Cover sucking chest wound with nonporous dressing taped on 3 sides
*Stabilize impaled objects
*Place patient in a semi-Fowler’s position or on injured side
*After ruling out cervical spine injury
*Administer analgesia
*Prepare for emergency needle decompression

Question 18

sucking chest wound care

Answer 18

(an open chest wound)
*Cover with nonporous dressing taped on 3 sides

Question 19

when there is a chest wound with an impaled object

Answer 19

*Stabilize impaled objects with bulky dressings. Do not remove object.

Question 20

Chest Tubes and Pleural Drainage

Answer 20

-To remove air or fluid from pleural and/or mediastinal space
-Reestablishes negative pressure
-Lung reexpands

Question 21

Flutter (Heimlich) Valve

Answer 21

-One-way valve that is used to evacuate air from the pleural space, attached to a drainage bag that has a vent opening

Question 22

Bubbling in water-seal chamber indicates

Answer 22

air leak

Question 23

Tidaling in water chamber of chest tube reflects

Answer 23

*changes in pressure, this will disappear as lung reexpands

Question 24

treatments for lung cancer

Answer 24

chemo, radiation, or surgery

Question 25

SE of chemo

Answer 25

-NV; anorexia -mucosal irritation -alopecia -mood changes/depression

Question 26

nadir

Answer 26

WBC count LOW after chemo and makes the patient at increased risk for oppportunistic infection (usually 10-14 days after chemo)

Question 27

Chemo precautions

Answer 27

isolation for patient, no fresh flower, fruit or veggies

Question 28

clinical manifestations of lung cancer

Answer 28

*Anorexia, fatigue, weight loss *Nausea/vomiting *Hoarseness *Unilateral paralysis of diaphragm *Dysphagia *Palpable lymph nodes

Question 29

PET scan

Answer 29

scans for metastasis by giving glucose, tumors love glucose so they will soak it up and the scan will light up where there is a tumor

Question 30

thoracotomy

Answer 30

incision of the chest

Question 31

lobectomy

Answer 31

removal of a lobe

Question 32

Pneumonectomy

Answer 32

removal of a lung

Question 33

post op concerns of thoracotomy

Answer 33

*Pain *Chest tubes *Respiratory distress and effort *Daily CXRs for lung re-xpansion *Pneumonectomies—area fills with fluid

Question 34

if a lung transplant is done, what does the patient need to do

Answer 34

-take antirejection medications (on the minute and hour, lifelong) -vaccinations (not live ones)

Question 35

3 meds specific to suppress immune system:

Answer 35

-Mycophenolate Cellcept -Tacrolimus -Prednisone

Question 36

Rejection signs and symptoms:

Answer 36

Fever, chills, fatigue, dyspnea, cough, low O2 sats