Observe for he moptysis fresh blood in the emesis

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often a late indicator of respiratory distress.Observe for he- moptysis (fresh blood in the emesis), dyspnea, decreased breath sounds, wheezes, crackles, and a transient tempera- ture elevation. Inspect the thorax for symmetric chest wall movement and equal presence of breath sounds in both lungs.The child may initially appear well but requires careful and thorough monitoring to detect signs of deterioration. Children with significant injuries are cared for in the ICU. Some children require ventilator support as the pulmonary tissues heal. PNEUMOTHORAX A pneumothorax occurs when air enters the pleural space because of tears in the tracheobronchial tree, the esopha- gus, or the chest wall. If blood collects in the pleural space, it is called a hemothorax, and if blood and air collect, it is called a pneumohemothorax. A pneumothorax is one of the more common thoracic injuries in pediatric trauma patients. There are three types of pneumothorax: open, closed, and tension.An open pneumothorax,sometimes referred to lon23944_ch47.qxd 2/17/06 2:40 PM Page 1433
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1434 CHAPTER 47 Parenial pleura (outer lining) Air in pleural space Visceral pleura (inner lining) Partially collapsed lung Pneumothorax Pneumothorax A, A pneumothorax is air in the pleural space that causes a lung to collapse.Whether the air results from an open injury or from bursting of alve- oli due to a blunt injury, it is important to focus on airway management and maintain lung inflation. B, Tension pneumothorax, note the collapsed lung on the patient’s right side and the deviation of the child’s heart and trachea to the right side of the chest. Courtesy of Dorothy Bulas, M.D., Professor of Radiology and Pediatrics, Children’s National Medical Center,Washington, DC. A B as a sucking chest wound, results from any penetrating in- jury that exposes the pleural space to atmospheric pressure, thereby collapsing the lung. A sucking sound may be heard as the air moves through the opening on the chest wall. A closed pneumothorax is sometimes caused by blunt chest trauma with no evidence of rib fracture (see “Patho- physiology Illustrated: Pneumothorax”). The chest may be compressed against a closed glottis,causing a sudden increase in pressure within the thoracic cavity. The child sponta- neously holds his or her breath when the thorax is struck, ac- counting for the involuntary closing of the glottis. The pressure increase is transferred to the alveoli, causing them to burst.A single burst alveolus may be able to seal itself off, but with the destruction of many alveoli the lung collapses. Breath sounds are decreased or absent on the injured side, and the child is in respiratory distress.A thoracostomy is per- formed and a chest tube inserted (see Skill 14–15.) A closed drainage system is attached to help remove the air and reinflate the lung by reestablishing negative pressure. A tension pneumothorax is a life-threatening emer- gency that results when the air leaks into the chest during SKILLS inspiration but cannot escape during expiration. Internal pressure continues to build, compressing the chest con- tents and collapsing the lung. Venous return to the heart
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  • Fall '14
  • Respiratory distress, Sleep apnea

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