Chest Trauma, Pneumothorax, and Pulmonary Embolism Review

Flashcard study set covering chest trauma, emergency management, open and tension pneumothorax, chest tubes and drainage systems, and pulmonary embolism based on lecture material.

What are the two main mechanisms of chest trauma injury described in the lecture?

Blunt trauma (shearing and compression injuries of chest structures) and penetrating trauma (foreign object impales or passes through body tissues creating an open wound).

What signs of respiratory distress should be assessed during emergency management of chest trauma?

Dyspnea, cough with or without hemoptysis, cyanosis, tracheal deviation, decreased breath sounds, decreased $O_2$ saturation, and frothy secretions.

What clinical manifestations indicate cardiovascular compromise in a patient with chest trauma?

Rapid, thready pulse; decreased BP with narrowed pulse pressure and/or asymmetric readings; distended neck veins; muffled heart sounds; chest pain; and dysrhythmias.

What target oxygen saturation level should be maintained during initial emergency management of chest trauma?

Apply $O_2$ to keep $SpO_2 > 90\%$.

How should an open sucking chest wound be covered during initial emergency interventions?

Cover the sucking chest wound with a nonporous dressing taped on three sides.

How does a nonporous dressing taped on three sides work during inspiration and expiration?

During inspiration, the dressing is pulled against the wound so air cannot enter the pleural space. During expiration, the dressing pushes out so air can escape.

What is the proper emergency protocol for managing an impaled object in the chest?

Stabilize the impaled object with a bulky dressing, but do not pull it out.

What pathophysiological change occurs in the pleural space during a pneumothorax?

Air enters the pleural cavity, creating positive pressure in the pleural space that causes the lung to partially or fully collapse.

What is the difference in manifestations between a small pneumothorax and a large pneumothorax?

A small pneumothorax causes mild tachycardia and dyspnea. A large pneumothorax causes respiratory distress and absent breath sounds over the affected area.

What diagnostic study is used to confirm a pneumothorax?

Chest x-ray.

What risk factors are associated with a spontaneous pneumothorax?

Being tall, thin, male, having a family history, or having a previous spontaneous pneumothorax.

What is an iatrogenic pneumothorax and what medical procedures can cause it?

A pneumothorax caused by medical procedures, such as biopsies, subclavian catheter insertion, mechanical ventilation, or esophageal trauma.

What physiological collapse mechanism occurs in a tension pneumothorax?

Air accumulates in the pleural space and cannot escape, resulting in increased intrapleural pressure, mediastinal shift, and hemodynamic instability due to reduced venous return and reduced cardiac output.

According to this diagram of a tension pneumothorax, what structural displacement occurs as air accumulates in the pleural space?

The accumulating air pushes against the lung causing a mediastinal shift and tracheal deviation away from the affected side, compressing the superior and inferior vena cava.

What immediate emergency treatment is required for a tension pneumothorax?

Immediate needle decompression followed by chest tube and water-seal drainage.

What are the primary functions of a chest tube?

To drain the pleural space, reestablish negative pressure, and allow the lung to expand.

What chest tube sizes are indicated for removing air, fluid, or blood?

Small tubes for air, medium tubes for fluid, and large tubes for blood.

What is the standard anatomical insertion site and patient positioning for chest tube placement?

The standard insertion site is midaxillary with the HOB elevated 30 to 60 degrees and the patient's arm raised above their head.

According to this chest tube placement diagram, where are chest tubes placed to remove air versus draining fluid and blood?

Chest tubes are placed high in the second intercostal space to remove air, and placed lower to drain fluid and blood.

What are the functions of the three compartments in a basic pleural drainage system?

1st compartment (collection chamber): retains fluid while air vents to the 2nd compartment; 2nd compartment (water-seal chamber): contains $2\,cm$ of water to act as a one-way valve allowing air to escape without re-entering; 3rd compartment (suction control chamber): uses a column of water or dry regulator dial to control suction.

What does tidaling in the water-seal chamber represent, and when does it stop?

Tidaling is the normal fluctuation of water with pressure changes during respiration. It disappears as the lung re-expands or if an occlusion occurs.

What chest drainage thresholds require immediate notification of the healthcare provider?

Drainage greater than $200\,mL/hr$ in the first hour and greater than $100\,mL/hr$ thereafter.

What immediate action should a nurse take if a chest drainage unit breaks?

Place the distal end of the chest tube in $2\,cm$ of sterile water in a container, then replace the unit.

Why is routine clamping of chest tubes during transport or disconnection not recommended?

Clamping increases the risk of developing a tension pneumothorax.

What breathing technique should a patient perform while a chest tube is being removed?

The Valsalva maneuver.

What is a Pulmonary Embolism (PE), and which region of the lungs is most commonly affected?

A PE is the blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue. It most often affects the lower lobes.

Where do most deep vein thrombosis (DVT) clots originate that lead to a Pulmonary Embolism?

Deep veins of the legs, femoral or iliac veins, right side of the heart (atrial fibrillation), and pelvic veins.

What is a saddle embolus?

A large thrombus located at the arterial bifurcation of the pulmonary arteries.

What is the most common clinical manifestation of a Pulmonary Embolism, present in 85% of cases?

Dyspnea.

What complications can arise from a Pulmonary Embolism?

Pulmonary infarction (leading to alveolar necrosis, hemorrhage, abscess, and pleural effusion) and pulmonary hypertension (from hypoxemia with massive $>50\%$ or recurrent emboli, leading to right ventricular hypertrophy).

What is the most common diagnostic study used to detect a Pulmonary Embolism?

Spiral (helical) CT scan / CT angiography (CTA).

When is a Ventilation-Perfusion (V/Q) scan performed to diagnose a Pulmonary Embolism?

When a patient cannot receive IV contrast media.