Respiration - entire physiologic process in which O2 exchanged through the
alveolar/capillary membrane.
Ventilator Rate - The number of inhalation and exhalation (breathing) per
minute.
Respiratory Rate - Is the amount of exchange within the body.
Cellular level.
Paradoxic motion - indicated a flailed chest and the broken part moves in
the opposite movement of the ventilation effort.
PNEUMOTHORAX AND HEMOTHORAX
Air or blood or both in the plural space.
First sign and symptom is dyspnea. Followed by decreased breath sounds,
unequal chest rise.
If pneumothorax BP will stay the same or go up and JVD.
If hemothorax BP stays the same or goes down and no JVD.
Paramedic care place needle decompression (dart the chest) to let air our
of plural space. 2nd/3rd mid clavicle and/or 5th/6th midaxially.
EMT care ABC's and transport.
CARDIAC TAMPONADE
A bleeding heart that collects in the sac around the heart - pericardial
sac.
Think of a Cardiac Tamponade just like a collapsed lung and plural space.
BECK'S TRIAD are signs and symptoms for Cardiac Tamponade. Muffled
heart tones (because of blood in the sac around heart), JVD (the heart cannot
pump because of the pressure to blood backs up in vessels), narrowing
pulse pressure.
Doctor will stick a long needle into chest and place in pericardial sac
and drain the blood.
EMS care ABC's and transport.
FLAILED CHEST
2 or more consecutive ribs broken in 2 or more places. Makes an
island.
Cause paradoxical motion.
EMS care is to try to limit external motion of flailed segment. Hold
a pillow, trauma dressing around chest.
NO SAND BAGS.
RIB FRACTURES
Can kill you.
Can cause internal bleeding.
Can cause air/blood in plural space.
Can cause you to not inflate your lungs fully and pneumonia can develop.
ATELECTASIS is when alveoli are not inflated and collapse decreasing the
surface area.
EMS care is ABC's
TENSION PNEUMOTHORAX
This is nothing new to you. This is a pneumothorax that gets bigger
and gets worse. Just like hyperglycemia can turn into DKA. Same
thing just worse.
Most tension pneumothrax's are caused by medical people. When an EMT
gets to the scene the patient has shallow breathing and slow. The EMT
uses a BVM to increase volume and rate causing more are into plural space
faster. Dead is dead, you have to breath for them in this case.
Signs and symptoms of tension pneumothorax - since this is worse more air
has collected causing no chest rise on the affected side. No breath
sounds on affected side. Tracheal deviation to unaffected side (late.
late sign).
Paramedic darts the chest or chest tube placement to fix the leak and get
air out of plural space.
OPEN CHEST WOUND CARE
Known as sucking chest wound.
Air can enter the plural space. Collapsing lungs.
Transport on left side if possible.
Think of the hole like your mouth. When you breathe in
air will enter the hole. When you exhale the air will exit the hole.
Use an occlusive dressing to cover the hole. If
breathing gets worse unseal the occlusive when they exhale and seal before
they inhale to let air out.
Dressing types. Tape occlusive dressing on three sides
to form a FLUTTER VALVE. By taping only three sides when the patient exhales
air goes out and when they inhale the occlusive will seal. Just like the flap
on a non-rebreather mask.
Dressing types – Tape occlusive dressing on all four
sides. If needed open when they exhale and close when they inhale.
On an exam if you have to pick chose three sides
(flutter) versus four sides if the choice is not both are correct.
TRAUMATIC ASPHYXIA
A mechanism that holds or pushes the chest wall inward.
Examples. A cave-in and the patient is in dirt up to chest.
The pressure pushes blood to head and squashes the body. The Addison
Airport when the mechanic went under the airplane and the wheels collapsed and
the plane smashed his body that was under the plane and his head was out and
popped.
Signs - blue face, bulging blue tongue, blood from eyes, ears, nose.
Throat triples in size. Dead if not already dead. This all depends
on the force on the body. If the person is still talking what do you
think will happen when the item squeezing them is removed?
Care ABC's, PASG to keep pressure up. Load and go.
CHEST INJURIES