• sudden compression to chest wall
• causing
• hypoxemia or pneumothorax
• hypovolemia or hemothorax
• cardiac tamponade
• cardiac contusion

• ribs 1-3 rare high mortality
• ribs 5-9 most common
• lower ribs - spleen liver injuries

• anterior chest pain
• ecchymosis
• crepitus
• chest wall deformity

• 3 or more ribs are fx on the same side, free floating rib segments
• hypoxemia
• resp acidosis
• hypotension
• increased dead space
• ↓alveolar ventilation

• mechanical ventilation
• corrective surgery
• analgesic pain meds

• damage to the lung tissues resulting in hemorrhage and edema
• causes flail chest, blunt force trauma
• countercoup contusion

• ↓ breath sounds
• tachypnea
• tachycardia
• crackles
• hypoxemia(cyanosis)
• alt loc
• cough

Basic principles ?

• pressure in chest cavity is lower than atmospheric
• chest is open, neg pressure is lost and lung collapses
• chest tube placed in between visceral/parietal pleura to replace normal neg pressure

• spontaneous
• non traumatic
• ruptured air filled bleb
• severe emphysema or chronic lung disease
• chest pain
• tachypnea to ards

• hole in chest/lungs
• acts as a vent so pressure from trapped air cannot build up in the chest

• air enters during inspiration and is trapped in the pleural space
• natural one valve mechanism
• lung collapses
• shift towards unaffected side
• mid clavicular 2nd intercostal space fb chest tube

• air
• upper portion of body
• 28 fr
• 2nd intercostal space

• lower portion of chest
• blood
• >32 fr
• 4 or 5th intercostal space

• pressure of the fluid in the pericardial space impairs cardiac filling
• pericardiocentesis - needle to remove fluid
• pericardiectomy - pericardial window

• sx procedure to create fistula from pericardial space to the pleural cavity
• allows effusion to drain and prevent tamponade

• hypotension
• JVD
• muffled cardiac sounds

• aorta is torn or ruptured
• rupture just distal to the origin of the left subclavian artery

• hoarse
• difficulty speaking
• sob
• chest pain, upper back pain

• inflammation of both layers:parietal / visceral
• pleural rub -dry
• worse with deep breathing, cough
• pain to shoulder or abdomen
• as pleural fluid increases pain decreases

• transudate fluid has passed thru a membrane
• exudate - bacterial inflammation or tumors
• decreased breath sound
• dull percussion

• fluid in alveolar / interstitial space
• agitation
• dyspnea crackles
• cyanosis pink froth
• tachycardia
• acc muscles

• thrombus in the pulmonary artery or branch
• tachypnea
• dyspnea
• chest pain
• anxiety
• fever
• tachycardia
• cough
• hemoptysis

• anticoagulant
• heparin induced thrombocytopenia (HIT) syndrome
• antidote - protamine sulfate
• Monitor with PTT

• heparin induced thrombocytopenia
• adverse drug reaction
• ↓ in platelet count
• hit/t is thrombocytopenia(low platelets) and thrombosis(blood clot)
• high mortality

• lovenox
• low molecular heparin
• <HITS
• antidote - protamine sulfate

• plavix
• platelet aggregation inhibitor
• prevents clots
• for strokes mi blood clots
• no antedote

• coumadin
• anticoagulant
• PT/INR
• Antidote vit K
• affected by diet/meds
• frequent blood monitoring