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 Lungs
 Mediastinum
◦ Heart
◦ Aorta and great
vessels
◦ Esophagus
◦ Trachea
 Diaphragm contracts
 Moves down
 Increasing the volume of the
thoracic cavity
 When the volume increases, the
pressure inside ________.
◦ aka?
 Pressure within the lungs is
called intrapulmonary pressure
 Phrenic nerve stimulus stops
 Diaphragm relaxes
 This ______ the volume of the
thoracic cavity
 Lung volume decreases,
intrapulmonary pressure _____.
If two areas of different pressure communicate, gas
will move from the area of higher pressure to the
area of lower pressure
◦ Parietal pleura
◦ lines the chest wall
◦ Visceral pleura (pulmonary)
◦ covers the lung
Parietal pleuraVisceral pleura
Normal Pleural Fluid Quantity:
Approx. 10-20 mL per lung
Lung
RibsIntercostal
muscles
• The area between the pleura is called the pleural space
(sometimes referred to as “potential space”)
• Normally, vacuum (negative pressure) in the pleural space
keeps the two pleura together and allows the lung to expand
and contract
• If air or fluid enters this space, there is a potential for
impaired breathing.
archive.student.bmj.com/.../02/education/52.php
 Diagnostic tests
 Client position
 Treatment depends on severity
◦ Chest tube
◦ Heimlich valve on chest tube
 Also called “thoracic catheters”
 Different sizes
 From infants to adults
 Small for air, larger for fluid
 Different configurations
 Curved or straight
 Types of plastic
 PVC
 Silicone
 Coated/Non-Coated
 Heparin
 Decrease friction
 In what setting/environment is a chest tube
placed?
◦ A. Operating Room
◦ B. Bedside
◦ C. Emergency Room
◦ D. All of the above
◦ E. None of the above
 Sterile technique
 Small incision
 Tube is sutured
 Dressing applied
◦ What type?
Choose site
Explore with finger
Place tube with clamp
Suture tube to chest
Photos courtesy trauma.org
Chest test presentation

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Chest test presentation

  • 1.
  • 2.  Lungs  Mediastinum ◦ Heart ◦ Aorta and great vessels ◦ Esophagus ◦ Trachea
  • 3.  Diaphragm contracts  Moves down  Increasing the volume of the thoracic cavity  When the volume increases, the pressure inside ________. ◦ aka?  Pressure within the lungs is called intrapulmonary pressure
  • 4.  Phrenic nerve stimulus stops  Diaphragm relaxes  This ______ the volume of the thoracic cavity  Lung volume decreases, intrapulmonary pressure _____.
  • 5. If two areas of different pressure communicate, gas will move from the area of higher pressure to the area of lower pressure
  • 6. ◦ Parietal pleura ◦ lines the chest wall ◦ Visceral pleura (pulmonary) ◦ covers the lung
  • 7. Parietal pleuraVisceral pleura Normal Pleural Fluid Quantity: Approx. 10-20 mL per lung Lung RibsIntercostal muscles
  • 8. • The area between the pleura is called the pleural space (sometimes referred to as “potential space”) • Normally, vacuum (negative pressure) in the pleural space keeps the two pleura together and allows the lung to expand and contract • If air or fluid enters this space, there is a potential for impaired breathing.
  • 9.
  • 10.
  • 12.
  • 13.
  • 14.
  • 15.  Diagnostic tests  Client position  Treatment depends on severity ◦ Chest tube ◦ Heimlich valve on chest tube
  • 16.  Also called “thoracic catheters”  Different sizes  From infants to adults  Small for air, larger for fluid  Different configurations  Curved or straight  Types of plastic  PVC  Silicone  Coated/Non-Coated  Heparin  Decrease friction
  • 17.  In what setting/environment is a chest tube placed? ◦ A. Operating Room ◦ B. Bedside ◦ C. Emergency Room ◦ D. All of the above ◦ E. None of the above
  • 18.
  • 19.
  • 20.  Sterile technique  Small incision  Tube is sutured  Dressing applied ◦ What type?
  • 21. Choose site Explore with finger Place tube with clamp Suture tube to chest Photos courtesy trauma.org

Editor's Notes

  1. Pressure DECREASES Aka -- intra thoracic pressure
  2. Lung volume ---- decreases Pressure – INCREASES Lungs are naturally elastic – once stretched – they RECOIL Pressure inside is greater than pressure outside --- cheeks will puff out
  3. Constantly produced and resorbed 100-200 mL produced daily Normal present at any one time --- 10mL
  4. Negative pressure --- below atmospheric pressure
  5. Air enters --- pressure causes lung collapse
  6. Pleural effusion, pneumothorax Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation. A pneumothorax (pl. pneumothoraces) is an abnormal collection of air or gas in the pleural space that separates the lung from the chest wall and which may interfere with normal breathing.
  7. Tension pneumonia Tension pneumothorax: a one way valve allows air into the pleural space during inspiration but not out during expiration
  8. Fig 3 Flail chest. The flail segment moves paradoxically during respiration On inspiration the flail section sinks in with mediastinal shift to the uninjured side On expiration, the flail section bulges outward with mediastinal shift to the INJURED side Paradoxical movement
  9. Visual assessment Xray CT
  10. Answer=D OR - usually through thorocotomyA thoracotomy or thoracostomy is an incision into the pleural space of the chest. It is performed by surgeons (or emergency physicians under) to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine (the latter may be necessary to access tumors in the spine). ED - sitting position or lying down with affected side elevated Bedside
  11. --- IF AIR is removed ------- anteriorly Second intercostal space requires dissection of pectoral muscles ----IF FLUID is removed – posteriorly , 8th – 9th intercostal space Some are using 4th-5th anterior or midaxillary line AIR – tube is directed apically Fluid – tube is directed inferiorly and posteriorly
  12. Dressing type Some use gauze – Some use petroleum jelly 2 chest tubes yes use y tube connector Clamped – keep air from going in