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Merkle, A. (2021). Care of a chest tube. Retrieved September 30, 2021, from httpswww.ncbi.nlm.nih.govbooksNBK556088 Campbell, E. & Lynn, C. (nd). Chapter 4 The Physical Examination. Retrieved from

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Merkle, A. (2021). Care of a chest tube. Retrieved September 30, 2021, from httpswww.ncbi.nlm.nih.govbooksNBK556088 Campbell, E. & Lynn, C. (nd). Chapter 4 The Physical Examination. Retrieved from (1)

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Thoracostomy tube -  is a minimally invasive procedure wherein a thin plastic tube is inserted into the pleural space which is the area between the chest wall and lungs, and may be attached to a suction device to remove excess fluid or air.

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1. Establish a normal/effective respiratory pattern with ABGs within the normal range.
2. Be free of cyanosis and other signs/symptoms of hypoxia.
3. Correct/avoid environmental and physical hazards.
4. Identify signs/symptoms requiring medical follow-up.

5. Follow the therapeutic regimen and demonstrate lifestyle changes.

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1. Continuously monitor the adequacy of oxygenation (pulse oximetry, ABGs) o Instruct breathing  techniques  such  as  diaphragmatic/pursed-lip  breathing,  and  coughing

exercises every two (2) hours.
2. Position the head of the bed 30 to 40 degrees during the immediate postoperative period.
3. Position the patient with the good lung down. The position should change from flat to semi-upright as soon as possible.
4. Administer pain medications (Morphine IV, combination of Lidocaine and Prilocaine).
5. Emphasize the importance of progressively increasing the activity.

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To establish a plan of care, the focus should be on the following:

1. Improvement of gas exchange and breathing

2. Relief of pain and discomfort

3. Understanding of self-care procedures

4. Absence of complications

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1. Impaired Gas Exchange Related to lung impairment or surgery
2. Ineffective Breathing Pattern Related to:

Decreased lung expansion (air/fluid accumulation)

Musculoskeletal impairment

Pain

Inflammatory process

3. Deficient Knowledge Related to Lack of exposure to information

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Perform hand hygiene

Assemble the drainage system

Opens drain package and prepares drain as per manufacturers instructions

Positions patient for procedure

Reassure the patient and explain the steps to be carried out during the procedure.

Monitor vital signs and for discomfort

Look for bleeding, infection, leakage of air and fluid around the tube

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Traumatic pneumothorax is caused by an injury that tears your lung and allows air to enter the pleural space. Could be caused by an incident such as a car accident, broken ribs, or a stab wound. This is the area between your lungs and your chest wall. The air trapped in your pleural space prevents your lung from filling with air, which causes it to collapse.

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Is Chest tube insertion necessary for this patient?

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Is Chest tube insertion necessary for this patient?

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Thoracentesis is a procedure to remove fluid or air from around the lungs. It is indicated for the symptomatic treatment of large pleural effusions. The need for emergency thoracentesis of the patient is due to dyspnea, asymmetrical chest expansion, slight tracheal shift on the right side and retractions as confirmed by physical examination and chest radiography.

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Does the patient's condition present an emergency situation in managing moderate traumatic open pneumothorax?

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Does the patient's condition present an emergency situation in managing moderate traumatic open pneumothorax?

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Chest X-ray: slight tracheal shift on the right side, retractions noted

SaO2: 94%

pH: 7.34

PaO2: 100 mmHg

PaCO2:45 mmHg

HCO3: 18 mEq/L

Hgb: 9.0 mg/dL

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T: 38.0 degrees Celsius
HR: 124 bpm
RR: 26 bpm
BP: 100/70 mmHg

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NA

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Chest X-ray - an imaging test that uses electromagnetic waves to create pictures of the structures in and around the chest.
Pulse Oximetry - measures the oxygen saturation of the blood and the pulse rate. It is used to assess adequacy of oxygenation and need for supplemental O2.
Arterial Blood Gas Test (ABG) - measures the acidity (pH), levels of oxygen and carbon dioxide in the blood from an artery. It is used to assess how well the lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.
Normal values:

pH (7.35-7.45)

PaO2 (75-100 mmHg)

PaCO2 (35-45 mmHg)

HCO3 (22-26 meq/L)

Base excess/deficit (-4 to +2)

SaO2 (95-100%)

Hemoglobin (Hgb) test - measures the amount of hemoglobin the red blood cells contain. Hgb is a protein produced by the bone marrow that is stored in red blood cells. It may be ordered as part of a complete blood count (CBC) test and is used to determine amount of blood loss and anemia.
Normal value:

For men, 13.5 to 17.5 g/dL

For women, 12.0 to 15.5 g/dL

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Vital signs are indicators of the body's most fundamental functions. The following are the four primary vital signs that medical experts and health care providers monitor on a regular  basis namely temperature, heart rate, respiratory rate, and blood pressure.

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Physical examination is the process of evaluating objective anatomic findings through the use of observation, palpation, percussion, and auscultation.

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A medical history includes an inquiry into the patient's medical history, past surgical history, family medical history, social history, allergies, and medications the patient is taking or may have recently stopped taking.

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A medical history includes an inquiry into the patient's medical history, past surgical history, family medical history, social history, allergies, and medications the patient is taking or may have recently sto

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After which, assessment took place.

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Winchester was sent to the emergency room.

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After the stabbing incident, Winchester feels he is unable to breathe properly.

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After a heated discussion between the two, the employee stabbed Winchester with an unknown object.

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Winchester, a 22-year-old male had an argument with one of the employees at the Shell gas station.

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