what is flail chest
consecutive rib fractures or sternum fracture that causes a rib cage segment to become free floating resulting in an unstable chest way
how does flail chest effect breathing pattern
paradoxical (asymmetrical chest movement occurs) where flail segment moved opposite of normal chest wall which increases the work of breathing
what happens to the flail segment on inspiration
gets sucked in
what happens to flail segment on respiration
bulges out
what are the S/S of flail chest
paradoxical breathing, rapid/shallow RR, splinting, crepitus, CO2 retention (respiratory acidosis), cardiac failure
what is the treatment for flail chest
stabilize flail segment (sand bags), positive pressure ventilation to fully expand lungs, pain meds, NG tube to prevent abdominal distention
what is a pneumothorax
air enters the pleural cavity and as pressure build up the ling begins to collapse reducing lung volume
what are the causes of pneumothorax
penetrating trauma (open), spontaneous (closed)
what are the S/S of a pneumothorax
SOB, chest pain, decreased O2% and BP, increased HR
what is the treatment of a pneumothorax
needle decompression
what is a potential complication fo a pneumothorax
can lead to tension pneumothorax
what is a tension pneumothorax
air in the pleural space that can escape causing life threatening increased intraplueral pressure
what are the S/S of a tension pneumothorax
mediastinal shift to unaffected side (good lung gets compressed), hemodynamic instability (CO and BP), increased RR/SOB, subcutaneous emphysema, tracheal deviation, no breath sound on affected side
what is the treatment of tension pneumothorax
chest tube to re-expand the lung
what kind of dressing should an emergency treatment of a tension pneumothorax have
dressing with 3 sides secure to allow air flow (pulled against wound during inspiration so air get get in and pushed out in expiration so air can escape)
what is pulmonary edema
fluid filled alveoli resulting in decreased gas exchange
what is the cause of pulmonary edema
increased atrial and left ventricle pressure (ex: heart failure)
what are the S/S of pulmonary edema
fluid accumulation, frothy pink sputum, early on respiratory alkalosis which leads to acidosis then hypoxemia
what is the treatment for pulmonary edema
vasodilators (decrease vascular resistance), diuretics (decrease preload and excess fluid), digoxin (increase contractility)
what position should a patient with pulmonary edema be placed in
elevate HOB, good lung down
what is a pulmonary embolism
blockage of a pulmonary artery or a clot that lodges into small blood vessels that blocks alveolar perfusion (alveoli are ventilated but not perfused)
what are the risk factors for developing a pulmonary embolism
venous stasis, endothelial injury, hyper-coagulability, ortho surgeries, reduced mobility
what are the S/S of a pulmonary embolsim
dyspnea, hypoxemia, chest pain, change in LOC
what are tests to diagnose a pulmonary embolism
d-dimer, CT aniography
what is the treatment for pulmonary embolisms
oxygen, pain meds, anticogaulants
what actions can be taken to prevent pulmonary embolisms
intermittent pneumatic compression, early ambulation, anticoagulants
what is acute respiratory distress sydrome
an acute lung injury where the alveolar capillary membrane is damaged and more permeable to intravascular fluid causing fluid to go where it isnāt supposed to resulting in an inflammatory response
what are the causes of acute respiratory distress syndrome
sepsis, shock, trauma
what are the S/S of acute respiratory distress syndrome
rapid onset of hypoxemia that does improve with O2, tachypnea and tachycardia, dyspnea, early respiratory alkalosis, retractions
what is the treatment for acute respiratory distress syndrome
bronchodilators, corticosteroids, antibiotics, hydration, oxygen
what position should a patient with acute respiratory distress syndrome be placed in
prone
what is the purpose of chest tubes
drain pleural space of air, fluid, or blood to reestablish negative pressure and allow the lung to reexpand
when should a chest tube be removed
when the lung is re-expanded or drainage is minimal
what patient education should be provided during a chest tube removal
bear down during removal
what is tidaling in a chest tube
normal rising and fall of the ball in the eater seal chamber with inhalation and exhalation
what could the lack of tidaling indicate
lung re-expanded, kink tube, obtruction
what does continuous bubbling in the water seal chamber of a chest tube indicate
air leak (find location by pinching tube to see if bubbling stops)
what occurs when oxygenation, ventilation, or both are inadequate
acute respiratory failure
what does hypoxemia indicate
insufficient O2 transferred to blood
what is the classification for hypoxemia
PaO2 < 60 on greater than 60% O2
what does hypercapnic indicate
insufficient CO2 removal
what classifies hypercapnia
PaCO2 > 50 or acidosis (pH<7.35)
what is hypoxemic respiratory failure
inadequate oxygenation caused by a diffusion limitation and alveolar hypoventilation
what are the S/S of hypoxemic respiratory failure
O2 sats <90%, retractions, paradoxical chest movement, combative, cool clammy skin, hypotension
what is hypercapnic respiratory failure
inadequate ventilation leads to increased CO2 levels
what are the S/S of hypercapnic respiratory failure
tripod position, decreased tidal volume and minute ventilation, morning HA, increased ICP, HTN, bounding pulse, muscle weakness and decreased DTR
what is the treatment for acute respiratory failure
position good lung down, oxygen, TCDB, hydration
why do we use the good lung-down position
enhances blood circulation to the good lung using gravity which increases perfusion and oxygenation of blood
why do we use the prone position
improves ventilation and keeps the alveoli open