respiratory

what is flail chest

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 isn’t 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