AMS1

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Author:
alyn217
ID:
162840
Filename:
AMS1
Updated:
2012-07-17 12:28:56
Tags:
AMS1T1 Chest Trauma
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Description:
Chest Trauma, Thoracic injury, PE
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  1. Basic facts about chest trauma
    • Thoracic injury – causes death in 20-25% of trauma victims
    • Chest wall injury – 45% of thoracic traumas
    • Examples: Blunt trauma, Penetrating trauma
  2. Pneumothorax
    • Air in pleural space – collapsed lung
    • Closed – no open wound
    • Open – chest wall open, ie wound Stab, gunshot, surgical
    • Tension Pneumo – air rapidly entering pleural space--> Tension on heart/vessels-->EMERGENCY!
    • --treated with chest tube to Remove air/fluid from pleural space and encourage Re-expansion of lungs
  3. Hemothorax
    • Blood in intrapleural space
    • May be hemopneumothorax
  4. Rib fxr
    • Most common chest trauma injury
    • PAIN!!!
    • --Shallow breathing
    • --Atelectasis
    • Multiple rib fx – unstable chest wall – Flail Chest (with inspiration, one side of chest will collapse instead of expand. Think asymetrical expansion)
    • --aka Paradoxical movement to intact chest
    • --Inadequate ventilation
  5. Pleural Effusion
    • Fluid in the pleural space
    • Sign of serious disease
    • Transudative: noninflammatory conditions – accumulation of protein-poor, cell-poor fluid. Caused by 1. incr hydrostatic pressure of HF (most common); 2. decr oncotic pressure (hypoalbuminemia) from chronic liver or kidney dz.
    • Exudative
    • Empyema: contains pus. Pneumonia, TB, lung abscess, post op infection.
    • Thoracentesis: diagnostic & therapeutic.
  6. Pulmonary Embolism (PE)
    • Thrombus, air or fat, tumor blockage of pulmonary arteries
    • Gains venous access then pulmonary circulation
    • DVT, R heart, pelvic veins
    • Mortality 30% without tx; 2-8% with tx.
    • SnSs: pt may be purple from head to nipple level.
  7. Risk factors for PE
    • Immobilization
    • Surgery
    • Obesity
    • Advancing age
    • Hypercoagulability
    • Hx of thromboembolism
    • Smoking + estrogen therapy
  8. SnSs of PE
    • Common: anxiety, sudden dyspnea, tachypnea, tachycardia
    • “Classic sx triad”: dyspnea, chest pain, hemoptysis (only 20% display these sx)
    • Mild/mod hypoxemia – low PaCO2
    • Cough, pleuritic CP, hemoptysis, crackles, fever, incr pulmonic heart sound (S3 & S4), mental status change
  9. Collaborative care of pt w/PE
    • ABG
    • O2 – cannula/intubation
    • TDBC
    • Vasopressors
    • Diuretics
    • Analgesia
    • Anticoagulants
    • Surgery
    • Pink, frothy sputum.
  10. Diagnostics related to PE
    • VQ (ventilation/perfusion) scan
    • D-dimer
    • Lung CT scan, spiral CT

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