chest tubes
what pressure amount of pressure would be put in the suction chamber of a water seal chest tube drainage system? is it positive or negative?
20cm
what can cause autonomic dysreflexia? when can it happen?
distended bladder, rectal impaction, clothes too tight, pain, a wrinkle in the sheet.
it can happen at anytime
how do you calculate CPP? what is the normal range of CPP?
CPP=MAP-ICP
normal range is 60-100
<60 leads to ischemia -> hypoxia
<30 means death (infarcted brain tissue)
what is hypoxemic respiratory failure?
what is CPAP?
continuous positive airway pressure
what is the difference between a pneumothorax, tension pneumothorax and hemothorax?
pneumothorax- caused by air entering the pleural cavity.
tension pneumothorax- occurs when air enters the pleural space but cannot escape
hemothorax- an accumulation of blood in the pleural space from injury to the chest wall, diaphragm, lung, blood vessels or mediastinum
what is poikilothermia?
the inability to adjust body temperature to room temperature
what are the clinical s/s of a diffuse axonal injury?
decreased LOC
increased ICP
decorticate or decerebrate posturing
global cerebral edema
**90% will remain in a persistent vegetative state
what is ARDS?
damage to alveolar capillary membrane then aveoli fill with fluid and results in severe dyspnea, hypoxia, decreased lung compliance with diffuse pulmonary infiltrates
what is mechanical ventilation and how many types are there?
mechanical ventilation is the process by which the FiO2 is moved in and out of the lungs by a mechanical ventilator.
2 types positive pressure and negative pressure.
If the chest tube falls out, what are your two most important things to do?
1. dressing taped on 3 sides with petroleum jelly
2. place the end of the tube into sterile water
what are signs of autonomic dysreflexia and how do you treat the patient?
signs: hypertension (up to 300 SBP), throbbing headache, anxiety, blurred vision, bradycardia, diaphoresis (above level of injury), nausea, nasal congestion
TX: raise the HOB, cath (if bladder is distended), digital rectal exam, remove all stimuli (clothes, shoes, blankets), monitor BP
what head injury is associated with battles sign and raccoon eyes?
basilar skull fx
what is hypercapnic respiratory failure?
**also known as ventilatory failure
PaCO2 >50 with acidemia (arterial pH <7.35)
**the main problem is insufficient CO2 removal
what is normal cerebral blood flow?
the amount of blood in mm passing through 100g of brain tissue in 1 min.
global cerebral blood flow is 50ml/min/100g of brain tissue
What are the 3 chambers on the chest tube drainage system?
1. collection- drainage coming out of patient's pleural space.
2. water seal- *tidaling is normal, *continous bubbling after initial placement means an air leak
3. suction chamber (can be dry (uses a dial) or water (uses water))
What are the 5 types of spinal cord injuries that can occur?
flexion
hyperextension
compression
flexion rotation
extension rotation
what is a subdural hematoma and an epidural hematoma? which is a medical emergency?
subdural-bleeding between the dura mater and arachnoid layer of the meninges
epidural- results from bleeding between the dura and inner surface of the skull.
***epidural is a medical emergency***
what the stages of ARDs and how long do they last?
injury or exudative phase 1-7 days
reparative or proliferative phase 1-2 weeks
fibrotic or chronic/late phase 2-3 weeks after injury
what is BiPAP?
bilevel positive airway pressure. delivers oxygen and two levels of + pressure support
high inspiratory positive airway pressure
lower expiratory positive airway pressure
where is the chest tube inserted for air? and where is it inserted for fluid drainage?
air- 2nd intercostal space
drainage- 5th or 6th intercostal space
where does neurogenic shock occur in SCI and what does it look like?
can occur in cervical or high thoracic (T6)
hypotension, bradycardia
what makes up intracranial pressure?
what is normal ICP range?
what does the monroe kellie doctrine state?
Brain tissue (78%), Blood (12%), Cerebrospinal fluid (10%)
5-15
3 components must remain at a constant volume within closed skull structure, if any volume increases then the volume from another component must decrease. ability to compensate is limited.
occurs when oxygenation, ventilation or both are inadequate
ABG's and pulse oximetry
What is the normal range of pH, PaCO2, HCO3?
pH- 7.35-7.45
PaCO2- 35-45
HCO3- 21-28