Reference no: EM133260243

LT, 53 years old, is brought to the emergency department by EMTs. LT was reportedly driving home during an ice storm after eating dinner at a friend's house. Her vehicle went into a skid and crashed into a tree. She has multiple injuries; however, she was wearing a seatbelt. LT's medical history includes a 10-year history of severe COPD with cor pulmonale. Her social history is positive for a 30-year history of smoking between 1 and 1-1⁄2 packs of cigarettes per day; she does not consume alcoholic beverages.

1. Explain the baseline arterial blood gas abnormalities you can anticipate on the patient's arrival at the ED, based on her history of COPD.

Clinical Update: A rapid evaluation of LT's injuries shows a possible chest contusion, as bruising is noted on her right chest wall, where she likely hit the steering wheel. You auscultate her chest, finding no lung sounds in her right upper lobes. A portable chest x-ray confirms a right-sided pneumohemothorax. Chest tube insertion is ordered, and on completion of the procedure the tubing is attached to a chest drainage system that is connected to low wall suction.

1. Based on the fact that she has a pneumohemothorax, where will the patient's chest tube(s) be placed? Explain why.
2. The chest tubes have been inserted and are now connected to the drainage system. You are preparing to dress the tube insertion sites and stabilize the drainage tube system. (A) Describe the dressing that you will apply, (B) explain why you chose that type of dressing, and (C) discuss how you will stabilize the drainage tubes.

Clinical Update: It is now day 1 postadmission. LT is in the trauma ICU. She has been breathing spontaneously, with oxygen at 28%. She responds appropriately to commands, although slowly. She has a nasogastric tube in place. You note that LT is becoming more tachypneic, her breathing appears more labored with each hour, she begins wheezing, and her mucous membranes appear cyanotic. A chest film is ordered, which shows diffuse opacities in her right lower lung field. It is decided that she may have an aspiration syndrome.

1. What risk factors does LT have for aspiration syndrome?
2. It is decided that LT has developed aspiration pneumonitis. Briefly explain how this form of aspiration differs from aspiration pneumonia.