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تخذير.ppt
- 1. Respiratory Emergencies Prepared by Fatma Shoeib Ali Assist. Prof. of Critical Care and Emergency Nursing Faculty of Nursing-Cairo University
- 3. Outlines Anatomy of Thorax Main Causes of Chest Injuries Different Types of Chest Injuries Signs and symptoms of Chest Injuries Primary assessment Secondry assessment Treatments of Chest Injuries Summery
- 4. Objectives : after this lecture the student will be able to: Define respiratory emergencies List causes of respiratory emergencies Describe general impression of pateint with respiratory emergencies Enumerate general sings and symptoms
- 5. Discuss initial assessment for respiratory emergencies Discuss ; def.,risk factors, manifestation, dignostic procedures , nursing care and complications of the following Rib fractures Flail chest Pneumothorax Haemothorax Cardiac tamponade
- 6. Introduction
- 7. Respiratory emergencies means any respiratory problem threats the patient’s life and requires immediate intervention. Respiratory Emergencies
- 8. •Chest trauma is often sudden •and dramatic •Accounts for 25% of all trauma deaths •2/3 of deaths occur after reaching hospital
- 9. Anatomy of the chest Two Lungs (right and left) Heart Diaphragm
- 10. Anatomy of the chest Pleural Space
- 11. Anatomy of the chest
- 12. Main Causes of Chest Trauma Blunt Trauma- Blunt force to chest. E.g. automobile crashes and falls. Penetrating Trauma- Projectile that enters chest causing small or large hole. E.g. gun shot and stabbing. Compression Injury- Chest is caught between two objects and chest is compressed.
- 13. Causes of Respiratory Emergencies Failure of: – Ventilation: air in/ air out – Diffusion: movement of gases – Perfusion: movement of blood
- 14. Chest Injuries Rib fractures Flail chest Pneumothorax Haemothorax Cardiac tamponade
- 15. Rib Fracture A rib fracture is a break in a rib bone. Cause is blunt chest trauma (fall, blow to the chest, etc).
- 16. Sings and symptoms Localized pain Tenderness over the fractured area on inspiration and palpation Shallow respiration Pain when coughing Swelling and bruising in the fracture area Internal bleeding Pneumothorax or heamothorax
- 17. HOW TO DIAGNOSE? CHEST XRAY
- 18. MANAGEMENT Most rib fracture heals in 3 – 6 weeks. Generally treated conservatively with rest, local heat and analgesics. Monitor for the sign of associated injuries. Rest and do not do physical activity. Adequate pain relief
- 19. Flail Chest The breaking of 2 or more ribs in 2 or more places resulting in free- floating rib segments.
- 20. Flail Chest The flail segment has no bony or cartilaginous connection Moves independently of the chest wall Paradoxical chest movement
- 21. Flail Chest
- 22. S/S of Flail Chest Shortness of Breath Paradoxical Movement Bruising/Swelling Crepitus( Grinding of bone ends on palpation) Tachycardia Hypotension
- 23. PARADOXICAL MOVEMENT The flail portion of the chest is sucked in with inspiration, instead of expanding outward
- 24. Flail Chest is a True Emergency
- 25. Diagnosis: Palpation : crepitus and tenderness near fractured ribs. chest x-ray ABGs
- 26. Management of Flail Chest ABC’s with c-spine control as indicated High Flow oxygen that may include Monitor Patient for signs of Pneumothorax or Tension Pneumothorax Contact hospital as soon as possible
- 27. Bulky Dressing for splint of Flail Chest Use Trauma bandage to splint ribs.
- 28. BLS Plus Care Monitor Cardiac Rhythm Establish IV access Airway management to include Intubation Observe for patient to develop Pneumothorax and even worse Tension Pneumothorax If Tension Develops Needle Decompress affected side Rapid Transport! Remember a True Emergency
- 29. Simple/Closed Pneumothorax Opening in lung tissue that leaks air into chest cavity Blunt trauma is main cause May be spontaneous Usually self correcting
- 30. S/S of Simple/Closed Pneumothorax Chest Pain Dyspnea Tachypnea Decreased Breath Sounds on Affected Side
- 31. Treatment for Simple/Closed Pneumothorax ABC’s with C-spine control Airway Assistance as needed If not contraindicated transport in semi- sitting position Provide supportive care Contact Hospital as soon as possible
- 32. BLS Plus Care Cardiac Monitor IV access and Draw Blood Samples Provide Airway Management which includes possible Intubation Monitor for Development of Tension Pneumothorax
- 33. Open Pneumothorax Opening in chest cavity that allows air to enter pleural cavity Causes the lung to collapse due to increased pressure in pleural cavity Can be life threatening and can deteriorate rapidly
- 41. S/S of Open Pneumothorax Dyspnea Sudden sharp pain Subcutaneous Emphysema Decreased lung sounds on affected side Red Bubbles on Exhalation from wound
- 42. Subcutaneous Emphysema Air collects in subcutaneous fat from pressure of air in pleural cavity Feels like rice crispies or bubble wrap Can be seen from neck to groin area
- 43. Treatment for Open Pneumothorax ABC’s with c-spine control as indicated High Flow oxygen Listen for decreased breath sounds on affected side Apply occlusive dressing to wound Notify Hospital as soon as possible
- 45. BLS Plus Care Monitor Heart Rhythm Establish IV Access and Draw Blood Samples Airway Control that may include Intubation Monitor for Tension Pneumothorax
- 46. Tension Pneumothorax Air builds in pleural space with no where for the air to escape Results in collapse of lung on affected side that results in pressure on mediastium,the other lung, and great vessels
- 47. Tension Pneumothorax Each time we inhale, the lung collapses further. There is no place for the air to escape..
- 48. Tension Pneumothorax Each time we inhale, the lung collapses further. There is no place for the air to escape..
- 49. Tension Pneumothorax Heart is being compressed The trachea is pushed to the good side
- 50. S/S of Tension Pneumothorax Anxiety/Restlessness Severe Dyspnea Absent Breath sounds on affected side Tachypnea Tachycardia Poor Color Accessory Muscle Use JVD Hypotension Tracheal Deviation (late if seen at all)
- 51. Treatment of Tension Pneumothorax ABC’s with c-spine as indicated High Flow oxygen including BVM Needle Decompression of Affected Side Treat for S/S of Shock Notify Hospital as soon as possible
- 52. BLS Plus Care Monitor Cardiac Rhythm Establish IV access and Draw Blood Samples Airway control including Intubation
- 53. Needle Decompression Locate 2-3 Intercostal space midclavicular line Cleanse area using aseptic technique Insert catheter ( 14g or larger) at least 3” in length over the top of the 3rd rib( nerve, artery, vein lie along bottom of rib) Remove Stylette and listen for rush of air Place Flutter valve over catheter Reassess for Improvement
- 55. Nursing Diagnosis Impaired Gas Exchange Ineffective Breathing Pattern Acute Pain
- 56. Nursing Diagnosis Anxiety Disturbed Body Compromised Family Coping
- 57. NURSING INTERVENTIONS Continuous respiratory assessment Optimizing oxygenation and ventilation, Maintaining the chest tube system Providing comfort and emotional support Maintaining surveillance for complications.
- 58. Hemothorax Occurs when pleural space fills with blood Usually occurs due to lacerated blood vessel in thorax As blood increases, it puts pressure on heart and other vessels in chest cavity Each Lung can hold 1.5 liters of blood
- 59. Hemothorax
- 60. Hemothorax
- 61. Hemothorax
- 62. Hemothorax
- 63. Hemothorax
- 64. Hemothorax May put pressure on the heart
- 65. S/S of Hemothorax Anxiety/Restlessness Tachypnea Signs of Shock Frothy, Bloody Sputum Diminished Breath Sounds on Affected Side Tachycardia
- 66. Treatment for Hemothorax ABC’s with c-spine control as indicated Secure Airway assist ventilation if necessary General Shock Care due to Blood loss Chest tube for drainage Consider Left Lateral Recumbent position if not contraindicated RAPID TRANSPORT Contact Hospital as soon as possible
- 67. BLS Plus Care Monitor Cardiac Rhythm Establish Large Bore IV preferably 2 and draw blood samples Airway management to include Intubation Rapid Transport If Development of Hemo/Pneumothorax needle decompression may be indicated
- 68. NURSING DIAGNOSIS Ineffective Airway Clearance Ineffective Breathing Pattern Impaired Gas Exchange Pain Risk for Infection Activity Intolerance Anxiety
- 69. NURSING DIAGNOSIS Impaired tissue perfusion Ineffective individual coping Altered health maintenance
- 70. Nursing Intervention Frequent and prompt Respiratory assessment Adequate oxygenation Analgesia to improve ventilation. Clearing secretion Stabilize the thoracic cage Deep breathing exercises Intubation and mechanical ventilation may be required to prevent further hypoxia
- 71. Nursing Intervention Pain Control Alternative to relieve pain: – Epidural Anesthesia. – Wearing a chest binder Maintain IV flow rates
- 72. Nursing Intervention Monitor S/S of adequate tissue perfusion Anxiety reducing techniques Coping mechanism Heath education/teaching
- 73. Pericardial Tamponade Blood and fluids leak into the pericardial sac which surrounds the heart. As the pericardial sac fills, it causes the sac to expand until it cannot expand anymore pericardial sac
- 74. Pericardial Tamponade Once the pericardial sac can’t expand anymore, the fluid starts putting pressure on the heart Now the heart can’t fully expand and can’t pump effectively.
- 75. Pericardial Tamponade With poor pumping the blood pressure starts to drop. The heart rate starts to increase to compensate but is unable The patient’s level of conscious drops, and eventually the patient goes in cardiac arrest
- 76. S/S of Pericardial Tamponade Distended Neck Veins Increased Heart Rate Respiratory Rate increases Poor skin color Hypotension Death
- 77. Treatment of Pericardial Tamponade ABC’s with c-spine control as indicated High Flow oxygen which may include What patient needs is pericardiocentesis Treat S/S of shock Rapid Transport Notify Hospital as soon as possible
- 78. BLS Plus Care Cardiac Monitor Large Bore IV access Rapid Transport
- 79. Initial Assessment Airway – open, no noises Breathing – 12-20 times per minute Circulation – warm, pink, dry, strong pulses Disability – mental status clear Vital Signs
- 80. General Impression of Patient Position Color Mental Status Ability to Speak Respiratory Effort
- 81. Is this patient in distress?
- 82. Look for pursed lip breathing or prolonged expiration
- 83. Tripod position suggests distress, resting weight on knees helps with chest expansion
- 84. Slow labored breathing is a sign of respiratory failure
- 85. Cyanosis – blue discoloration suggests hypoxia
- 86. Signs and symptoms Inadequate breathing: inadequate rate or volume , inadequate chest rise and fall, little air movement from mouth and nose diminished breath sounds during auscultation. Altered mental status. Tripod position.
- 87. Abnormal sounds: snoring, stridor, gurgling, coughing, wheezing, crackles. Use of neck muscles retractions of the intercostal muscles during breathing. See-saw motion of the chest and abdomen. Signs and symptoms: cont.,
- 88. Nasal flaring. Diaphoretic: sweaty from effort to breath. Having difficulty talking. Hypoxia signs: pallor, cyanosis, pulse-ox. below 95%, sluggish pupil response. Pursed lips during exhalation is characteristic of patients with chronic respiratory diseases. Signs and symptoms: cont.,
- 89. Agitated, confused facial expression. Pulsus paradoxus: drop in blood pressure (or pulse strength) during inhalation. Paradoxical motion: an area of the chest moves inward during inhalation and outward during exhalation. Abnormal pulse: fast at first due to anxiety, later slow because the heart is not getting enough oxygen. Signs and symptoms: cont.,
- 90. Summary Chest Injuries are common and often life threatening in trauma patients. So, Rapid identification and treatment of these patients is paramount to patient survival. Airway management is very important and aggressive management is sometimes needed for proper management of most chest injuries.
- 91. The END Questions? Comments Thank You