MDC4 Exam 2 - Lecture notes 5-9
WITH COMPLETE SOLUTIONS
UPDATED!!!
, lOMoAR cPSD| 47061011
Chest
• Pneumothorax: air that suddenly enters the pleural space causing loss of negative
pressure and reduction in vital capacity which can cause lung to collapse o Closed: air
in the chest that has entered through a hole in the lung o Open: air in the chest that
has entered through a hole in the chest wall o Spontaneous/iatrogenic pneumo: not
associated with trauma, blebs, damaged tissue in the lungs (COPD)
o Simple: air escapes from the injured lung into the pleural space, and negative
intrapleural pressure is lost, resulting in partial or complete collapse of the lung
o Tenison: air enters the intrapleural space but can’t escape of expiration;
increased intrathoracic pressure causes the lung to collapse
Pushes everything to the uninjured side including the heart; tracheal
deviateion in present with a tension pneumo
o Tension is worse than simple
o S/S: sudden chest pain, minimal respiratory distress, tachypnea, central cyanosis,
decreased chest expansion, breath sounds diminished/absent
o assessment: respiratory/circulatory function, lung sounds, tracheal deviation o
indications:
o interventions: cover wound, immediate chest decompression, chest tube,
monitor respiratory/circulatory, assess lung sounds, tracheal deviation, pain
management
• Rib Fracture: blunt trauma, increase risk of pulmonary contusion, pneumothorax,
hemothorax o S/S: pain on movement/respiration, asymmetrical chest movement,
splints chest defensively (reducing breathing depth/clearance of secretions)
o Assessment: preexisting lung disease= greater risk for atelectasis/PNA; deep
chest injury or poor prognosis= first and second rib, flail chest; 7 or more
fractured ribs, expired volumes <15ml/kg
o Interventions: uncomplicated fractures reunite spontaneously (usually not
splinted), decrease pain to maintain gas exchange (intercostal nerve block for
severe pain, analgesic that cause respiratory depression are avoided)
• Flail Chest: 2 or more fractures of 3 or more adjacent ribs creating free floating
fractured segment o S/S: paradoxical movement of chest wall, pain, dyspnea,
cyanosis, tachycardia, hypotension
o Assessment: paradoxical movement (segment goes in with chest expansion, out
with exhalation), ineffective ventilation o tx on a vent
if 100% O2 by non-rebreather face mask is not maintaining oxygen,
intubation and ventilator will be required
WITH COMPLETE SOLUTIONS
UPDATED!!!
, lOMoAR cPSD| 47061011
Chest
• Pneumothorax: air that suddenly enters the pleural space causing loss of negative
pressure and reduction in vital capacity which can cause lung to collapse o Closed: air
in the chest that has entered through a hole in the lung o Open: air in the chest that
has entered through a hole in the chest wall o Spontaneous/iatrogenic pneumo: not
associated with trauma, blebs, damaged tissue in the lungs (COPD)
o Simple: air escapes from the injured lung into the pleural space, and negative
intrapleural pressure is lost, resulting in partial or complete collapse of the lung
o Tenison: air enters the intrapleural space but can’t escape of expiration;
increased intrathoracic pressure causes the lung to collapse
Pushes everything to the uninjured side including the heart; tracheal
deviateion in present with a tension pneumo
o Tension is worse than simple
o S/S: sudden chest pain, minimal respiratory distress, tachypnea, central cyanosis,
decreased chest expansion, breath sounds diminished/absent
o assessment: respiratory/circulatory function, lung sounds, tracheal deviation o
indications:
o interventions: cover wound, immediate chest decompression, chest tube,
monitor respiratory/circulatory, assess lung sounds, tracheal deviation, pain
management
• Rib Fracture: blunt trauma, increase risk of pulmonary contusion, pneumothorax,
hemothorax o S/S: pain on movement/respiration, asymmetrical chest movement,
splints chest defensively (reducing breathing depth/clearance of secretions)
o Assessment: preexisting lung disease= greater risk for atelectasis/PNA; deep
chest injury or poor prognosis= first and second rib, flail chest; 7 or more
fractured ribs, expired volumes <15ml/kg
o Interventions: uncomplicated fractures reunite spontaneously (usually not
splinted), decrease pain to maintain gas exchange (intercostal nerve block for
severe pain, analgesic that cause respiratory depression are avoided)
• Flail Chest: 2 or more fractures of 3 or more adjacent ribs creating free floating
fractured segment o S/S: paradoxical movement of chest wall, pain, dyspnea,
cyanosis, tachycardia, hypotension
o Assessment: paradoxical movement (segment goes in with chest expansion, out
with exhalation), ineffective ventilation o tx on a vent
if 100% O2 by non-rebreather face mask is not maintaining oxygen,
intubation and ventilator will be required
