Extubation of course is always going to be your goal for client who is mechanically ventilated. Extubation is the removal of that tube, you want to hyper oxygenate the patient before you remove the tube thoroughly, suction ET tube. Most ET tubes have an end line suction available where you are able to suction down the tracheal tube itself and of course you use your younker to suction the oral cavity, the back of the throat, deflate the cuff on the ET tube, remove the tube at peak inspiration and instruct the patient to cough and it’s that easy the tube is out. And of course you have at your bedside some kind of mask usually a transition to a mask depending on the client, and of course the thing I did not say about extubation, really the first thing, is that make sure the patient is awake, alert and orientated, can follow commands, your sedation is off because you don’t want anything to impede their ability to take a breath. We will talk briefly about some chest trauma, about 25% of traumatic deaths result from chest injuries. This can be from contusions, refractions that can cause contusions, or pneumothoraxes, a flail chest. Pneumothorax, tension pneumothorax, hemothorax, and tracheobronchial trauma. Pulmonary contusion, potentially lethal injury, patient may be asymptomatic at first and can later develop respiratory failure and oftentimes you see these clients who have been MVAs. Patient presents essentially generally with bloody sputum, decreased breath sounds, particularly on one side, they can have crackles, and/or wheezes. Treatment of course, maintenance of ventilation and oxygenation, likely going to include perhaps chest tube, depending what is going on and/or mechanical ventilation. Refractions too also is also classified as chest trauma, the chest for treatment is not splinted by tape or other materials. The main thing is maintaining care for these clients is going to be focused on pain so that they will breathe, will take deeper breaths. You can imagine their flank or side hurting when they breathe in is what causes the pain, so they are taking poor puny breaths. And another thing that is going to help them there is that incentive spirometer. You even think about people who have had belly and GI surgeries, really don’t like to use their incentive spirometer because it causes pain in their gut. And so
you can imagine the patient who has a refraction. They don’t want to use their incentive spirometer because it causes pain and increases incidence of pain so we medicate them appropriately and we make them breathe because if they are not breathing effectively, what are they at risk for? Pneumonia, exactly. Flail chest, I always love to see these pictures of flail chest because they always look so crazy! Flail chest, pyridoxal chest moving, the sucking inward almost just looks like a I don’t know a jelly at that particular area. It looks like how it sounds, flail. You’d know if you saw it; it’s very peculiar and abnormal looking. So
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- Winter '16
- pulmonary edema, ARDS