Chest Trauma, Pneumothorax, and Pulmonary Embolism Flashcards

Vocabulary practice flashcards covering pathophysiology, clinical manifestations, nursing management, chest drainage systems, and pulmonary embolism.

Blunt Chest Trauma

Chest injury mechanism involving shearing and compression injuries of chest structures, where external appearance may be minor but severe internal organ damage can be present.

Penetrating Chest Trauma

Chest injury mechanism occurring when a foreign object impales or passes through body tissues, creating an open wound.

Respiratory Distress Assessment Signs

Clinical signs in chest trauma including dyspnea, cough with or without hemoptysis, cyanosis, tracheal deviation, decreased breath sounds, decreased $O_2$ saturation, and frothy secretions.

Cardiovascular Compromise Assessment Signs

Clinical signs in chest trauma including rapid, thready pulse, decreased BP with narrowed pulse pressure and/or asymmetric readings, distended neck veins, muffled heart sounds, chest pain, and dysrhythmias.

Initial Oxygen Therapy Target (Chest Trauma)

Oxygen administration aimed at maintaining an $SpO_2 > 90\%$.

Fluid Resuscitation Access (Chest Trauma)

Establishment of IV access using $2$ large-bore catheters to begin fluid resuscitation as appropriate.

Sucking Chest Wound Initial Dressing

Application of a nonporous dressing taped on three sides to cover the open wound.

Patient Positioning after Ruling Out Cervical Spine Injury

Placing the patient in a semi-Fowler's position or on the injured side.

Emergency Needle Decompression Preparation

Initial emergency intervention prepared for relieving dangerous intrapleural pressure in a tension pneumothorax.

Ongoing Monitoring in Emergency Chest Trauma

Continuous evaluation of vital signs, level of consciousness, oxygen saturation, cardiac rhythm, respiratory status, urinary output, and potential intubation.

Pneumothorax

A condition caused by air entering the pleural cavity, where positive pressure in the pleural space causes the lung to partially or fully collapse.

Open Pneumothorax

A pneumothorax characterized by an opening in the chest wall, such as from a penetrating trauma sucking chest wound.

Closed Pneumothorax

A pneumothorax with no external wound, suspected whenever chest wall trauma occurs.

Small Pneumothorax Manifestations

Mild tachycardia and dyspnea.

Large Pneumothorax Manifestations

Respiratory distress and absent breath sounds over the affected area.

Pneumothorax Diagnostic Study

Chest x-ray.

Spontaneous Pneumothorax

Pneumothorax caused by the rupture of blebs, which can occur in healthy individuals or those with chronic conditions such as COPD, asthma, cystic fibrosis, or pneumonia.

Spontaneous Pneumothorax Risk Factors

Risk factors including being tall, thin, male, having a family history, or a previous spontaneous pneumothorax.

Iatrogenic Pneumothorax

Pneumothorax resulting from medical procedures such as biopsies, subclavian catheter insertion, mechanical ventilator use, or esophageal trauma.

Tension Pneumothorax

An accumulation of air in the pleural space that cannot escape, resulting in increased intrapleural pressure, mediastinal shift, and hemodynamic instability.

Tension Pneumothorax Hemodynamic Effects

Hemodynamic instability caused by reduced venous return and reduced cardiac output.

Tension Pneumothorax Manifestations

Severe dyspnea, tachycardia, tracheal deviation, decreased or absent breath sounds on affected side, neck vein distention, cyanosis, and diaphoresis.

Three-Sided Dressing Mechanism on Inspiration

Inspiration pulls the dressing against the wound so air cannot enter the pleural space.

Three-Sided Dressing Mechanism on Expiration

Expiration pushes the dressing outward, allowing air to escape from the pleural space.

Management of Impaled Objects

Stabilizing the object in place with a bulky dressing without pulling it out.

Immediate Treatment for Tension Pneumothorax

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

Invasive/Surgical Treatments for Pneumothorax

Procedures including partial pleurectomy, stapling, or pleurodesis.

Chest Tubes

Tubes approximately $20\,\text{in}$ long inserted to drain the pleural space, reestablish negative pressure, and allow the lung to expand.

Chest Tube Size Selection

Tube sizing ($12^\circ$ to $40^\circ\text{ F}$) selected based on contents: small for air, medium for fluid, and large for blood.

Pigtail Tubes

Small chest tubes ranging from $10^\circ$ to $14^\circ\text{ F}$ used for drainage.

Standard Chest Tube Insertion Site

Midaxillary line.

Patient Positioning for Chest Tube Insertion

Elevating the head of bed $30$ to $60$ degrees with the patient's arm raised above the head.

Second Intercostal Space Chest Tube Placement

Chest tube placement high in the pleural space specifically positioned to remove air.

Diaphragm Level Chest Tube Placement

Chest tube placement low in the pleural space near the diaphragm specifically positioned to drain fluid and blood.

Collection Chamber (1st Compartment)

The first compartment of a pleural drainage unit where fluid stays in while air vents to the second compartment.

Water-Seal Chamber (2nd Compartment)

The second compartment containing $2\,\text{cm}$ of water; acts as a one-way valve where air goes in and bubbles out, but cannot return to the patient.

Suction Control Chamber (3rd Compartment)

The third compartment that uses a column of water or a dry regulator control dial to control suction pressure.

Water Suction Drainage Unit Mechanism

System requiring connection to a wall suction source dialed higher than prescribed, where the suction control chamber controls the wall suction pressure.

Dry Suction Drainage Unit Mechanism

System that controls wall suction pressure using a regulator control dial without requiring water in the suction control chamber.

Water-Seal Chamber Bubbling Pattern

Air bubbling that is brisk at first, eventually disappears as the lung expands, and occurs intermittently with exhalation, coughing, or sneezing.

Tidaling

Fluctuation of water in the water-seal chamber corresponding to pressure changes during respiration, which disappears as the lung re-expands.

Sudden Cessation of Tidaling

An indication to inspect the chest tube drainage system immediately for an occlusion.

Wet Suction Control Setting

Suction regulated by the level of water in the chamber (usually $20\,\text{cm}$), with usual prescribed suction orders at $-20\,\text{cm H}_2\text{O}$.

Proper Operation of Wet Suction Control Chamber

Adjusting wall suction until gentle bubbling occurs in the third compartment.

Decreasing Suction on Dry Suction Units

Action requiring the nurse to turn the dial regulator, depress the high-negativity vent, and check the water level in the water-seal chamber.

Chest Drainage Tubing Management

Keeping drainage tubing loosely coiled and ensuring all connections are kept tight and taped.

Essential Assessments for Chest Drainage

Regularly assessing vital signs, lung sounds, pain, drainage amount, drainage site for infection, and subcutaneous emphysema.

Recommended Patient Activities with Chest Tubes

Encouraging deep breathing, incentive spirometry, and range-of-motion exercises.

Chest Drainage Unit Position

Keeping the drainage system positioned below chest level at all times.

High Drainage Reporting Threshold (First Hour)

Drainage output greater than $200\,\text{mL/hr}$ in the first hour.

High Drainage Reporting Threshold (After First Hour)

Drainage output greater than $100\,\text{mL/hr}$ after the first hour.

Action for Chest Drainage Unit Breakage

Placing the distal end of the chest tube into $2\,\text{cm}$ of sterile water in a container and replacing the unit.

Milking or Stripping Chest Tubes

Handling practices that are explicitly not recommended or advocated due to dangerous pressure changes.

Chest Tube Dressing Care

Changing dressings according to agency policy using petroleum gauze and aseptic technique while monitoring for infection.

Chest Tube Clamping Policy

Practice not advocated during transport or disconnection due to the high risk of causing tension pneumothorax.

Indication for Brief Chest Tube Clamping

Clamping briefly only to change the chest drainage unit.

Monitorable Complications of Chest Tubes

Reexpansion pulmonary edema, hypotension, and severe subcutaneous emphysema.

Chest Tube Removal Protocol

Procedure performed when lungs are reexpanded and drainage is minimal; involves premedicating, having the patient perform the Valsalva maneuver during removal, applying an occlusive dressing, obtaining a chest x-ray, and monitoring for respiratory distress.

Pulmonary Embolism (PE)

Blockage of one or more pulmonary arteries by a thrombus, fat or air embolus, or tumor tissue.

Primary Anatomic Site Affected by PE

Lower lobes of the lungs.

Venous System Origins of PE

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

Non-Thrombotic Embolus Origins

Central venous catheters or arterial lines, fat (fracture), air (IV), vegetation on heart valves, amniotic fluid, and cancer.

Saddle Embolus

A large thrombus situated at the arterial bifurcation of the pulmonary artery.

Primary Risk Factors for PE

Immobility/reduced mobility, surgery within $3\,\text{months}$ (especially pelvic/lower extremity), history of VTE, cancer, obesity, oral contraceptives/hormone therapy, smoking, prolonged air travel, heart failure, pregnancy, and clotting disorders.

Most Common Manifestation of PE

Dyspnea, occurring in $85\%$ of patients along with mild-moderate hypoxemia.

Additional Clinical Manifestations of PE

Tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, tachycardia, syncope, and a pulmonic heart sound.

Manifestations of Massive PE

Change in mental status, hypotension, impending doom, and death.

Pulmonary Infarction

Complication resulting from occlusion of medium or large-sized vessels, inadequate collateral blood flow, and preexisting lung disease, leading to alveolar necrosis, hemorrhage, abscess, and pleural effusion.

Pulmonary Hypertension Secondary to PE

Complication resulting from hypoxemia associated with massive (greater than $50\%$) or recurrent emboli, leading to right ventricular hypertrophy.

D-Dimer Diagnostic Test

Laboratory test elevated with any clot degradation; false negatives can occur with small PEs.

Spiral (Helical) CT Scan / CT Angiography (CTA)

The most common diagnostic test for PE requiring IV contrast media to obtain a 3-D picture of pulmonary vasculature.

Ventilation-Perfusion (V/Q) Scan

Diagnostic test used if a patient cannot have contrast media; consists of perfusion scanning (radioisotope injection) and ventilation scanning (inhaled radioactive gas).

Non-Diagnostic Diagnostic Studies for PE

Arterial blood gases (ABGs), chest x-ray, electrocardiogram (ECG), troponin levels, and b-type natriuretic peptide (BNP).

Immediate Nursing Interventions for PE

Placing the patient on bed rest in semi-Fowler's position, assessing cardiopulmonary status, administering oxygen, IV fluids, and medications, and monitoring coagulation and complications.

Key Patient Education Topics for PE

Educating the patient regarding long-term anticoagulant therapy, measures to prevent VTE, and the importance of follow-up exams.