Page 132 - Critical Care Notes

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RESP
Can develop into tension pneumothorax → severe respiratory distress,
cyanosis, absent breath sounds on the affected side, sinus tachycardia
>140 bpm, JVD → tracheal deviation → midline shift, hypotension, changes
in mental status.
Diagnostic Tests
■ CXR
■ ABGs
■ CT scan
■ ECG
Management
■ Assess vital signs, skin color, breathing pattern, breath sounds, pain level,
and oxygenation.
■ Assess for arrhythmias.
■ Keep patient upright.
■ Administer O 2 as needed by nasal cannula or mask, and monitor O 2
saturation.
■ Administer analgesics as needed.
■ Insert chest tube (refer to section on Chest Tubes).
■ In the case of a small pneumothorax (usually <30%, no symptoms, and
uncomplicated), observe and monitor the patient for pneumothorax
resolution at 1.25% every day.
Thoracic Procedures
Thoracic Surgery
Segmental resection is the removal of the bronchus, a portion of the pulmonary
artery and vein, and tissue of the involved lung segment.
Lobectomy is the removal of an entire lobe of the lung.
Pneumonectomy is the removal of the entire lung, generally for treatment of
lung cancer, bronchiectasis, tuberculosis, or lung abscess. Removal of the right
lung is more dangerous because of its larger vascular bed.
Management
Pneumonectomy (Postoperative; First 24–48 Hours)
■ Routine postoperative care includes frequent assessments of cardiopulmonary
and hemodynamic status.
■ Patient should lie on back or operative side only. This prevents leaking of
bronchial stump, prevents fluid from draining into operative site, and
allows full expansion of remaining lung.
■ Perform CXR to check for deviation of trachea from midline indicating
mediastinal shift.
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