Page 678 - Clinical Application of Mechanical Ventilation

644 Chapter 19

Complications

Besides the tension hemopneumothorax, there were no apparent complications
from either the right lower lobe pneumonia or throughout the postoperative period
resulting from the mechanical ventilation. He was followed throughout his hospital
stay with respiratory therapy and continued treatments with deep breathing (IS)
regimens and with bronchodilator therapy for wheezing. His oxygen demands were
monitored with daily pulse oximetry and the oxygen flow was titrated to keep the
SpO above 90%. He was discharged on the eighth postsurgical day from the ter-
2
tiary care facility on room air and without further complications.

CASE 8: CHEST TRAUMA

INTRODuCTION

A.P. was a 24-year-old, 56-Kg female involved in a moving vehicle accident.
The patient was unrestrained and was struck on her side of the vehicle. She was
thrown from the vehicle, and her car was found to contain multiple prescription pain
medication bottles. She was apparently comatose at the scene with no spontaneous
breathing or pulse. However, her vital signs returned to normal en route to the hospital.
Upon arrival at the emergency department, her vital signs revealed a blood
pressure (BP) of 122/80 mm Hg, pulse of 80/min, normal sinus rhythm, and
temperature of 35.8°C. Her breathing was assisted by the respiratory care practi-
tioner (RCP) with a manual resuscitator bag. Breath sounds revealed diffuse coarse
rhonchi bilaterally without wheezing.
Laboratory and radiology results revealed a white blood cell (WBC) count of
The white blood count is 17.5 3 10 (normal 3.2 to 9.8 3 10 ), hemoglobin (Hb) of 12.7 g % (normal 12
3
3
significantly elevated.
3
3
to 15 g %), platelets of 195 3 10 (normal 130 to 400 3 10 ), prothrombin time
(PT) of 13 sec (normal 9 to 12 sec), and a partial thromboplastin time (PTT) of 30
sec (normal 22 to 37 sec). A portable chest radiograph (Figure 19-5) revealed rib
fracture on the right and bilateral infiltrates in which the left side was greater than
the right. The left hemidiaphragm, heart border, and parenchymal changes were
consistent with pulmonary contusion and/or possible aspiration pneumonitis.
Pulmonary contusion is The patient underwent an extensive evaluation of her injuries, including a computer-
an internal injury of the lung
parenchyma in which the skin ized tomography (CT) of her head that was essentially normal. Scans of her chest and
is not broken.
abdomen revealed bilateral rib fractures, pneumothoraces with blood accumulation,
and rupture of her spleen with evidence of free peritoneal fluid. Also noted was an
apparent transverse process fracture of the lumbar spine as well as probable posterior
Bilateral rib fractures and
pneumothoraces with blood element fractures of the T1 vertebrae. She also had multiple contusions and lacera-
accumulation limit chest tions, including a large laceration to the right axilla and in the right wrist region.
expansion and hinder ventila-
tion and oxygenation. Her previous history included smoking one pack of cigarettes per day and
chronic bronchitis.

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.