تخذير وعناية

1. Respiratory Emergencies
Prepared by
Fatma Shoeib Ali
Assist. Prof. of Critical Care and Emergency
Nursing
Faculty of Nursing-Cairo University

2. Respiratory
Emergencies

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

34. Open Pneumothorax

35. Open Pneumothorax
Inhale

36. Open Pneumothorax
Exhale

37. Open Pneumothorax
Inhale

38. Open Pneumothorax
Exhale

39. Open Pneumothoarx
Inhale

40. Open Pnuemothorax
Inhale

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

44. Occlusive Dressing

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

54. Needle Decompression

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