AH3 test 1 Questions and Answers Solved Correctly Rated A+
clinical indications for chest tube - Answers -pneumnothorax
-hemothorax
How a chest tube works - Answers -removes air and fluid from plueral cavity
-restores negative pressure
-promotes lung expansion and alevolar ventilation
subcutaneous air - Answers subcutaneous emphysema or crepitus
tidaling - Answers fluctuation of fluid in the water seal chamber
-normal
spontaneously breathing patient:
-water level rises during inspiration, falls during exhalation
-opposite for mechanically ventilated patient
-if tidaling is not present, assess for obstructing in the tubing (clot or kink)
signs of a pneumnothorax - Answers -bubbling in the water seal/air leak chamber
-first assess for a loose connection or break in the system
-check connections
-assessing for a system air leak
-chest radiograph will verify if there is a pneumnothorax
epidemiology of chest trauma - Answers -accounts for approximately 16,000 deaths anually
-throacic trauma is the direct cause in 20-25% of all trauma-related deaths in a contributory cause for an
additional 20-25% of deaths
-MVCs are the most prevalant cause of throacic injuries seen in emergency departments and trauma
centers
-older drivers older than 60 y/o are more susceptible to injury
-other risk factors include rate of speed, size of vehicle, seat-belt use
-at speeds greater than 25 mph, the occupants are more likely to be injured
,blunt chest trauma - Answers -sudden compression of positive pressure inflicted to the chest wall
-can be difficult to determine the extent of damage, symptoms may be vague, patients may delay
seeking treatment
blunt mechanisms - Answers acceleration
deceleration
shearing
compression
acceleration - Answers moving object hitting chest or patient being thrown at an object
-fall
-bike accident
-assault
deceleration - Answers -sudden decrease in rate and speed or velocity
-MVC
shearing - Answers -strecthing forces to areas of the chest causing tears, ruptures, or dissections
compression - Answers -direct blow to the chest such as a crash injury
-construction or heavy machinery
blunt chest injury results in one or more pathologic states - Answers -hypoxemia from disruption of
airway, injury to lung tissue, rib cage, and respiratory musculature: pneumnothorax
-massive hemorrhage
-hypovolemia from fluid loss, cardiac rupture, or hemothorax
-cardiac failure from caridac tamponade. cardiac contusion, or increased intrathoracic pressure
-can lead to impaired ventilation and perfusion, leading to hypovolemia, shock, death
penetrating - Answers a foreign object penetrates the chest wall
-gunshot and stab wounds are most common
-classified by velocity
-stab wounds are low velocity weapon destroys a small area around the wound
, -gunshot wounds : low, medium, or high velocity: extent of damage determined by distance, caliber of
gun, and type of bullet
-the appearance of the penetrating wound can be deceptive: extent of damage can be wide spread
assessment for blunt and penetrating - Answers rapid, complete assessment of injury is critical
-how injury occurred and time elapsed since injury
Initial assessment: life threatening injuries - Answers -inspection of airway, thorax, neck veins, breathing
pattern, tracheal shift
-respiratory effort: stridor, nasal flairing, use of accessory muscles, drooling
-breath sounds, symmectrical chest expansion
-may also accompany head and abdominal injuries
-continued assessing to detect early signs of clinical deterioration
diagnostic testing - Answers CXR, CT scan, FAST, CBC, APT, PT, INR, ABG, ECG
Sternal and Rib fractures - Answers -common chest trauma with in MVC from direct blow to the sternum
from steering wheel
-most rib fractures are benign, treated conservatively
-Fx of first 3 ribs are rare but higher mortality rate
-Fx of lower ribs associated with liver and spleen laceration
Assessment findings:
-sternal fracture: chest pain, overlying tenderness, ecchymosis, crepitus
Rib: severe pain, point tenderness, muscle spasm
-chest x-ray for dx
-complications: patients reluctant to move or deep breathe
-diminished ventilation: atelectasis, pneumonia, hypoxemia
-can progress to ARF
Flail chest - Answers -when 3 or more adjacent ribs are fractured at 2 or more sites; free floating rib
segments
-chest wall loses stability
clinical indications for chest tube - Answers -pneumnothorax
-hemothorax
How a chest tube works - Answers -removes air and fluid from plueral cavity
-restores negative pressure
-promotes lung expansion and alevolar ventilation
subcutaneous air - Answers subcutaneous emphysema or crepitus
tidaling - Answers fluctuation of fluid in the water seal chamber
-normal
spontaneously breathing patient:
-water level rises during inspiration, falls during exhalation
-opposite for mechanically ventilated patient
-if tidaling is not present, assess for obstructing in the tubing (clot or kink)
signs of a pneumnothorax - Answers -bubbling in the water seal/air leak chamber
-first assess for a loose connection or break in the system
-check connections
-assessing for a system air leak
-chest radiograph will verify if there is a pneumnothorax
epidemiology of chest trauma - Answers -accounts for approximately 16,000 deaths anually
-throacic trauma is the direct cause in 20-25% of all trauma-related deaths in a contributory cause for an
additional 20-25% of deaths
-MVCs are the most prevalant cause of throacic injuries seen in emergency departments and trauma
centers
-older drivers older than 60 y/o are more susceptible to injury
-other risk factors include rate of speed, size of vehicle, seat-belt use
-at speeds greater than 25 mph, the occupants are more likely to be injured
,blunt chest trauma - Answers -sudden compression of positive pressure inflicted to the chest wall
-can be difficult to determine the extent of damage, symptoms may be vague, patients may delay
seeking treatment
blunt mechanisms - Answers acceleration
deceleration
shearing
compression
acceleration - Answers moving object hitting chest or patient being thrown at an object
-fall
-bike accident
-assault
deceleration - Answers -sudden decrease in rate and speed or velocity
-MVC
shearing - Answers -strecthing forces to areas of the chest causing tears, ruptures, or dissections
compression - Answers -direct blow to the chest such as a crash injury
-construction or heavy machinery
blunt chest injury results in one or more pathologic states - Answers -hypoxemia from disruption of
airway, injury to lung tissue, rib cage, and respiratory musculature: pneumnothorax
-massive hemorrhage
-hypovolemia from fluid loss, cardiac rupture, or hemothorax
-cardiac failure from caridac tamponade. cardiac contusion, or increased intrathoracic pressure
-can lead to impaired ventilation and perfusion, leading to hypovolemia, shock, death
penetrating - Answers a foreign object penetrates the chest wall
-gunshot and stab wounds are most common
-classified by velocity
-stab wounds are low velocity weapon destroys a small area around the wound
, -gunshot wounds : low, medium, or high velocity: extent of damage determined by distance, caliber of
gun, and type of bullet
-the appearance of the penetrating wound can be deceptive: extent of damage can be wide spread
assessment for blunt and penetrating - Answers rapid, complete assessment of injury is critical
-how injury occurred and time elapsed since injury
Initial assessment: life threatening injuries - Answers -inspection of airway, thorax, neck veins, breathing
pattern, tracheal shift
-respiratory effort: stridor, nasal flairing, use of accessory muscles, drooling
-breath sounds, symmectrical chest expansion
-may also accompany head and abdominal injuries
-continued assessing to detect early signs of clinical deterioration
diagnostic testing - Answers CXR, CT scan, FAST, CBC, APT, PT, INR, ABG, ECG
Sternal and Rib fractures - Answers -common chest trauma with in MVC from direct blow to the sternum
from steering wheel
-most rib fractures are benign, treated conservatively
-Fx of first 3 ribs are rare but higher mortality rate
-Fx of lower ribs associated with liver and spleen laceration
Assessment findings:
-sternal fracture: chest pain, overlying tenderness, ecchymosis, crepitus
Rib: severe pain, point tenderness, muscle spasm
-chest x-ray for dx
-complications: patients reluctant to move or deep breathe
-diminished ventilation: atelectasis, pneumonia, hypoxemia
-can progress to ARF
Flail chest - Answers -when 3 or more adjacent ribs are fractured at 2 or more sites; free floating rib
segments
-chest wall loses stability
