Category: Critical Care Nursing Chest examination of a pneumothorax may reveal palpable crepitus, decreased breath sounds, decreased chest wall excursion or hyperresonance to percussion. Vital signs may be significant for tachycardia, hypoxia or tachypnea.
Category: Critical Care Nursing Many lung pathologies can contribute to the risk for pneumothorax, but a ruptured bleb from chronic obstructive pulmonary disease is most common. Patients with pneumothorax often complain of ipsilateral pleuritic chest pain and dyspnea.
Category: Critical Care Nursing Pneumothorax is caused by air from the alveoli or the surrounding atmosphere entering the space between the parietal and visceral pleura. Pneumothorax in the ICU is often iatrogenic, resulting from mechanical ventilation and procedures.
Category: Critical Care Nursing In aortic dissection, the initial management should focus on heart rate and blood pressure control, usually with beta-blockers, typically the rapidly titratable agent esmolol, and the use of a potent vasodilator such as nicardipine or clevidipine.
Category: Critical Care Nursing Hypotension often occurs with type A aortic dissection, whereas hypertension is more commonly seen in type B dissection. A significant difference in systolic blood pressure (> 20 mm Hg) between the upper extremities may be detected.
Category: Critical Care Nursing About one-quarter of patients with aortic dissection have pulse deficits in the carotid, radial or femoral arteries, and have neurologic deficits related to cerebral or spinal cord ischemia and therefore can present as having a stroke or paraplegia.
Category: Critical Care Nursing Many patients with thoracic aortic dissection complain of chest, back or abdominal pain that radiates to the back often describe the pain as sharp. It can also present in a painless fashion, manifesting as syncope, stroke or evolving heart failure.
Category: Critical Care Nursing Patients with thoracic aortic dissection who are younger than 40 years are more likely to have Marfan syndrome, Loeys-Dietz syndrome, bicuspid aortic valve, prior aortic surgery or aortic aneurysm.
Category: Critical Care Nursing Risk factors for thoracic aortic dissection include hypertension, male sex, pregnancy, atherosclerosis, diabetes mellitus, cocaine use, valvular disease, prior cardiac surgery, Ehlers-Danlos syndrome, Turner syndrome and giant cell arteritis.
Category: Critical Care Nursing Thoracic aortic dissection results from a tear in the aortic intima. The Stanford system classifies dissections as type A (involving the ascending aorta) or type B (involving the aorta distal to the left subclavian artery).
Category: Critical Care Nursing High-risk patients with hemodynamic instability and RV dysfunction resulting from pulmonary embolism may require systemic thrombolysis, with surgical embolectomy or catheter-directed thrombolysis.
Category: Critical Care Nursing Initial treatment of low-risk patients with pulmonary embolism involves anticoagulation with subcutaneous low-molecular weight heparin or fondaparinux, IV unfractionated heparin or direct oral anticoagulants.
Category: Critical Care Nursing A ventilation/perfusion scan can be time consuming and difficult to perform in mechanically ventilated patients, and interpretation is challenging in the presence of other lung pathology when ruling out pulmonary embolism.
Category: Critical Care Nursing CT pulmonary angiography can be rapidly performed and is the diagnostic test of choice for stable patients in whom there is moderate to high suspicion of pulmonary embolism, given its high sensitivity and specificity.
Category: Critical Care Nursing In pulmonary embolism, the ECG is often normal, but may show sinus tachycardia (the most common finding), Brugada pattern, atrial fibrillation or the classically reported S1Q3T3 (McGinn-White) pattern.
