Category: Critical Care Nursing Esophageal rupture may be caused by common ICU procedures, including nasogastric or tracheal intubation. Spontaneous rupture of the esophagus occurs from a sudden increase in intraluminal pressure, usually from vomiting or retching.
Category: Critical Care Nursing Most cases of esophageal perforation are caused by upper GI tract instrumentation. The risk of esophageal injury from an endoscopy is low but increases dramatically when interventions such as dilation or stents are performed.
Category: Critical Care Nursing A full-thickness tear of the esophagus carries a high mortality risk, because of the intense inflammatory response to gastric contents in the mediastinum and pleural space, resulting in a chemical and bacterial mediastinitis.
Category: Critical Care Nursing For the vast majority of patients, a small-bore catheter placed via the Seldinger technique is as efficacious as standard chest tube placement in those with primary spontaneous pneumothorax.
Category: Critical Care Nursing In patients with hemodynamic compromise from a suspected tension pneumothorax, treatment with immediate needle thoracostomy, followed by tube thoracostomy, should not be delayed while waiting for a chest x-ray.
Category: Critical Care Nursing In supine patients with pneumothoraces, a deep sulcus sign may be seen where the costophrenic angle extends more inferiorly than normal. Alternatively, a sharp delineation of the cardiac silhouette from the lucency may also be seen.
Category: Critical Care Nursing Chest x-rays are often performed in the semi-upright or supine position in the ICU, whereas the signature finding of pneumothorax, a visceral pleural line, is often seen only on an upright chest x-ray.
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.
