Unit 3 Chest tubes/Pneumothorax/Hemothorax

Question 1

What can be assessed in Rib contusion or fracture? How is it diagnosed?

Answer 1

Hemoptysis
Decreased BS
Crackles/Wheezes
Pain with movement
Splinting

Dx via CXR, CT scan

Question 2

What is the collaborative care for rib contusions and fractures/chest trauma?

Answer 2

Supplemental O2
Incentive spirometry 
C and DB
Activity
Pain management 
Pillow splint

Question 3

What is a Pneumothorax and what are the types?

Answer 3

Thoracic injury that allows accumulation of atmospheric air into pleural space; lung collapses.

Types:
Open (ex: penetrating wound)
Closed (ex: contusion damage, spontaneous)
Tension - air trapped into pleural space with each inspiration with no release during expiration, leads to complete collapse of lung

Question 4

What are the manifestations of a Pneumothorax?

Answer 4

Abnormal chest wall movement
Hyper-resonance (high-pitched sound)
Trachea deviation
Chest pain
Tachypnea
Subcutaneous emphysema (air entering skin of chest wall)

Question 5

What is the definite Dx for a Pneumothorax of any kind?

Answer 5

CXR (chest x-ray)

Question 6

Which is more likely to lead to a tension pneumothorax open or closed?

Answer 6

Open because with each inhalation air will continually keep getting trapped.

Question 7

What are the 3 parts to a chest tube drainage system? describe.

Answer 7

Suction control chamber (should have gentle suctioning, distilled water, usually 15-20)

Water seal chamber
(acts as one-way valve to let air escape, 2cm marker.)

Collection chamber
> 100 mL/hr should be notified

Question 8

What is the intervention for a Pneumothorax?

Answer 8

Chest tube! Allows for air to escape and lung segment to reinflate (placed high)

Question 9

What are other things that could cause a Pneumothorax?

Answer 9

Blunt chest trauma
Chest tubes
Mechanical ventilation (barotrauma)
Insertion of central venous catheter

Question 10

What are signs and symptoms of a tension Pneumothorax?

Answer 10

Asymmetry of thorax
Respiratory distress
Unilateral absence of BS
Distended neck veins
Cyanosis 

THIS IS AN EMERGENCY

Question 11

What is the intervention for a tension Pneumothorax? Hemothorax?

Answer 11

Chest tube
Large bore needle

In second intercostal space (placed high for Pneumothorax).

Chest tube between 5th and 6th intercostal space towards the side/back

Question 12

What is the interventions for a Hemothorax?

Answer 12

Chest tube placed LOW, between the 5th and 6th intercostal space, usually on the side.

Question 13

What is a Hemothorax?

Answer 13

Loss of blood into thoracic cavity

Usually caused by trauma or sx

Question 14

What are the manifestations of a Hemothorax? How is it confirmed?

Answer 14

• If small amount, may be asymptomatic
• Respiratory distress
• Decreased BS
• Dull to percussion
• Hgb and Hct might also be abnormal

-Confirmed by CXR and thoracentesis

Question 15

What is the collaborative management of a Hemothorax?

Answer 15

Evacuate blood
Normalize pulmonary function
Replace fluids
CHEST TUBE

Question 16

Regarding a Hemothorax, what amount of blood loss indicates an issue?

Answer 16

If initial blood loss is 1500-2000 ml or if there is bleeding of 200mL/hr over 3 hrs than PT may require Sx.

Question 17

What is Flail Chest?

Answer 17

Occurs with multiple fractured ribs (typically 3 in a row)

Paradoxical respirations. One of the most critical chest injuries.

Part of rib-cage is separated from rest of the chest and begins to move.

Question 18

What are the purposes of chest tubes?

Answer 18

Pneumothorax
Hemothorax
Pleural effusion
Lung abscess (infection)
Chest trauma

Question 19

What is a Heimlich valve?

Answer 19

One way valve to let air escape - dry suction

Question 20

What might be indicated if there are no fluctuations in the water-seal chamber? What about continuous bubbling?

Answer 20

Kink or lung has re-expanded.

Air-leak

Question 21

What should you never do regarding fluid in the tubes?

Answer 21

NEVER MILK IT

Question 22

What should normally be happening with the water seal chamber and the suction control chamber?

Answer 22

Water seal chamber:

• should slightly rise and fall with respirations
• *inverse when on MV**

Suction control chamber:
-should have gentle continuous bubbling