Page 280 - Clinical Application of Mechanical Ventilation

246 Chapter 9

TABLE 9-3 Conditions That Affect the Body Temperature

Conditions That May Cause Hypothermia Conditions That May Cause Hyperthermia

Infection CNS problem

Tissue necrosis Metabolic disorders
Leukemia Drugs and toxins

Increased metabolic rate Induced coronary bypass surgery
Head injury

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Excessive cooling of the phrenic nerve during CAB surgery may cause paralysis
Excessive cooling of the of the hemidiaphragms. This condition, though temporary, may take months to
phrenic nerve during CAB
surgery may cause paralysis of resolve completely (Wilkins & Dexter, 1998). Table 9-3 outlines the conditions that
the hemidiaphragms. affect the body temperature.

CHEST INSPECTION

Since the lungs are protected by the thoracic cage, they are not readily accessible for
direct examination. Chest inspection uses indirect methods to assess and evaluate
the lungs and related structures.

Chest Movement

During mechanical ventilation it is important to observe the overall chest movement.
One should observe the symmetrical movement of the chest with each inspiration
as well as the depth and rhythm of each tidal volume cycle.
Asymmetrical movement can occur in conditions such as right main-stem (bronchial)
intubation, atelectasis, and tension pneumothorax (Figure 9-1). If dysynchronous

A B C

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Figure 9-1 Asymmetrical chest movement due to (A) right bronchial intubation; note over-
inflation of the right lung and underinflation of the left lung; (B) atelectasis, the trachea and medi-
astinum are shifted to the affected side; (C) tension pneumothorax, the trachea and mediastinum
are shifted to the opposite unaffected side.

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