medsurg week 6:

Summary of Key Concepts in Rapid Response Team (RRT) and Chest Trauma Management

RRT Overview

  • Rapid Response Team (RRT): A team activated when a patient's condition deteriorates. The composition and response procedures are essential for effective care.

    • Primary Nurse Role: Initiates RRT based on patient assessment; prepares necessary equipment (oxygen, suction, etc.).

    • **Team Composition:

    • Respiratory Nurse

    • Phlebotomist (for ABG)

    • ICU Nurse

    • Nursing Supervisor (for information and assistance)

    • Respiratory Doctor (if needed)

  • Differences Between RRT and Code Blue:

    • RRT is for deteriorating patients; Code Blue is for cardiac arrest situations.

    • RRT can escalate to a Code Blue if the situation worsens.

Equipment and Protocols

  • Crash Cart: Always locked; do not open without need. Nurses may bring necessary equipment to the room.

  • ACLS Certification: Required for ICU staff; allows participation in advanced life support actions.

  • Primary Nurse Responsibilities During RRT:

    • Provide a clear report, including reason for RRT activation and patient status.

    • Stay with the patient unless necessary to retrieve equipment.

Chest Trauma Assessment

  • Primary Survey Focus:

    • ABCDs: Airway, Breathing, Circulation, Disability (assessments made quickly).

    • Common indicators of chest trauma include hypotension and tachycardia indicating possible hemorrhage.

  • Signs of Cardiac Contusion: Bruising around heart area due to trauma, possibly mimicking a myocardial infarction on EKG.

  • Symptoms of Respiratory Compromise: Hypoxia, abnormal breath sounds, potentially subcutaneous emphysema.

Intervention for Chest Trauma

  • Needle Thoracostomy: An emergency procedure to relieve tension pneumothorax.

    • Quick action is critical to avoid severe complications.

  • Inserting Chest Tube: After decompression, to drain fluids, blood, and air from pleural cavity.

Chest Drainage Unit (CDU)

  • CDU Structure: Has three compartments for drainage management.

    • Collection Chamber: Holds drainage; capacity up to 2000 ml.

    • Water Seal Chamber: Acts as one-way valve with 2 cm of water. Monitors backflow of air and fluid.

    • Suction Chamber: May be wet or dry; wet suction results in continuous bubbling.

Monitoring and Troubleshooting

  • Output Measurement:

    • First hour over 200 ml or greater after should be reported to provider.

    • Greater than 70 ml/hour thereafter prompts provider notification.

  • Immediate Action If Tube Becomes Dislodged:

    • Apply sterile gauze over site and tape three sides, ensuring that air can escape.

    • If tubing disconnected, immerse tube end in sterile water until reattached.

Important Procedures Related to Chest Tubes

  • Never clamp chest tubes: This may lead to increased pressure and complications such as tension pneumothorax.

  • Equipment Check: Consistently monitor CDU functionality; if the tidaline (bubbling) ceases, evaluate lung re-expansion and drainage needs.

General Protocols and Situational Awareness

  • Be prepared and know your department's equipment layout and accessibility for emergencies.

  • Always prioritize patient safety, especially during rapid intervention situations.