Pneumothorax Scenario

midchest discomfort. The chest pain has awakened him from sleep but does respond to NTG, which

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

Pulse rate is at 72. The blood pressure was 140 / 95,which is suggestive of high blood pressure and related to his medical history. No heart murmur was noted, and no other abnormalities were noted.

Patients who have suffered a traumatic injury may have a variety of different fluids and objects in their throat that could be obstructing it (Stephens, 2011). For example there could be blood, bodily fluids, and even teeth is the patient broke any teeth (Stephens, 2011). In order to clear this persons airway first the paramedic should observe for any large foreign bodies obstructing the airway, and if they can try to finger sweep it out (Stephens, 2011). If there are any fluids obstructing the patients airway the paramedic will suction the patients airway. The proper way to suction is to not go past the base of the patients tongue, and to suction as you are pulling the device out (Stephens, 2011). The maximum amount of time to suction an adults airway is fifteen seconds, and the maximum amount of time you can suction a child's airway is ten seconds (Stephens, 2011). The medic should always keep the suction on hand even after an airway has been inserted in case the patients airway needs to be suctioned

shortness of breath. Pain improved with sublingual Nitroglycerine and Aspirin given by EMS. On arrival to ED his blood pressure was 154/94, HR 70 bpm, RR 19 and SpO2 98% in room air. Heart, lung, abdominal and neurological examinations were unremarkable.

You will have a bandage (dressing) around the area where the VAD tube exits your abdomen. The dressing consists of a drain sponge, gauze, and adhesive tape. Your VAD coordinator may help you order the supplies you need to change your dressing.

This makes the assembly less cumbersome, and if properly trained, the measurement and drainage can be carried out sufficiently safely by the patient. The Heimlich valve system does not restrict the patient to the bed. This allows for patients who may require prolonged drainage to be nursed in the outpatient setting while being sufficiently independent. Additionally, there is no danger of the drained effluent, or air flowing back into the chest with assumption of a different or dependent position relative to the collecting bag. With a well secured thoracostomy tube, the patient enjoys relative freedom in terms of nursing positions (10).

I started my morning by reviewing his Kardex and noticed that chest pain had been noted and that he had an ECG and CT of his chest. I went into his room to find him wide-awake in bed. I performed my safety check and took his vitals. His resp rate was quite high at this time and his Sp02 was on the lower side. MK expressed through nodding that he was having chest pain during that time. I also did a respiratory assessment because I was concerned with his SpO2 and resp rate. I found decreased air entry to his bases, expiratory wheeze, and a visual use of accessory muscle to breath. His breathes where short and labored. When asked if he was experiencing SOB, he nodded and this directed my care for that morning. I reported to my instructor with my findings as this was the first time I had a client say yes to chest pain. I quickly addressed his SOB with his PRN bronchodilator using a spacer and put him on two liters of O2 via nasal prongs. I checked back in after 5 minutes and his resp rate had lowered and his SpO2 had risen to a more adequate level. I noticed he did not have audible wheeze any longer and was not using his accessory muscles. Overall he looked way more relaxed in his bed after addressing his respiratory distress. Unfortunately, he still was nodding yes to chest pain in that moment. The RN on my team left a doctors note about another CT and ECG and noted that the client was still

When you hook up or disconnect the ventilator or humidification tubing, hold the trach tube in place.

When inserting a catheter in a male or a female the cleaning process and the depth of insertion is different. The patient should lie in the supine position. Before getting started wash your hands and put on clean gloves. Open outer CSR wrap and remove the pad and lie it underneath the patient. Next use the provided castile soap wash to clean the patient’s per-urethral area. Remove gloves, apply hand sanitizer, and place sterile gloves on both hands. Be sure to place fenestrated drape on patient. Use the syringe with the green plunger to squirt lubrication in the tray. Remove the top tray and place it next to the bottom box being sure to leave it on the CSR wrap. Screw the water-filled syringe into the inflation port. Remove the catheter from the wrap and place it into the lubricant. Clean the patient with the pre-saturated antiseptic swab sticks. Using a female for our example take the first swab and move in a downward motion and clean the right labia minora and discard. Then take the second swab and repeat on the left labia minora. For the third swab stick clean the middle area between the labia minora. Proceed with the insertion of the catheter by inserting until urine flow is noticed. Once there is urine flow insert two more inches and inflate balloon with all 10mL of sterile water. Once inflated, pull the catheter until the

What is your primary diagnosis causing Jeremy’s chest pain? Include ICD 10 codes (eliminate differentials)

A few of the interventions included: proper hand hygiene, appropriate indwelling foley catheter care, and educating the patient on how to care for the incision. The nurse washed her hands and wore gloves before every incision check in order to reduce the amount of bacteria that could enter the site. Once the patient reached the PACU, the nurse immediately cleaned the foley catheter with antiseptic wipes. This action will be performed once a shift until the Foley catheter is removed. The nurse educated the patient on how to care for her incision site and explained to her the signs and symptoms of an

All patients were followed with pulmonary artery catheters and invasive blood pressure. After orotracheal intubation, patients were ventilated with intermittent positive pressure with a tidal volume of 8 mL / kg, final expiratory positive pressure of 5 to 8 cmH2O and FiO2 of 60 to 100% to maintain arterial oxygen saturation above 95%.

It is so crucial to confirm the tube placement because of possible harm that can be done to the patient. About 1.9% of feeding tubes are misplaced every year. This can lead to pneumothorax in 1 in every 5 patients and dead in 1 in 39 patients (Taylor S. et al., 2014). Using X-ray to confirm placement would be too late to prevent lung trauma. PH is done also but is not always accurate and should not be used solely as proof to confirm placement. Waiting on the confirmation of placement can delay the administration of treatment or nutrition. Using the EM tracking system the patient is less likely to have the tube enter the lungs. While a patient is unconscious their gag reflex is often impaired (Potter et al., 2013). This increases the patient’s risk for aspiration. When inserting the tube in an unconscious patient there is a greater risk for harm. Potter suggests that X-ray is the better option for confirmation of placement but X-ray exposure can also be harmful to the patient (Windle E. et al.,

Background: Occult Pneumothoraxes (OPTX) represents air within the pleural space that is not visible on conventional chest radiographs, but ultimately detected with CT . In a study comparing differences in pneumothoraces, while similar in size, patients significantly underwent tube thoracostomy compared with patients who had overt pneumothoraces1. While optimal management of occult pneumothoraxes has not been identified, the increased use of computed tomography has led to a rise in detection. Occult OPTX Extended focused assessment with sonography for Trauma, also known as eFAST, is screening test that has been shown to useful in identifying OPTX. Our aim of the present study is to identify if there are any differences in OPTX detections between