Carbamazepine is also used for
~ psychotic disorders, trigeminal neuralgia, and alcohol withdrawal
The therapeutic serum range of carbamazepine is
~ 5 to 12 mcg/mL
What should be monitored closely when a patient is taking a valproate?
~ liver enzymes
Seizures associated with fever usual...
✓~ Air in the pleural space that prevents lung expansion
What is normally in the pleural space?
, ✓~ 2.5mL of fluid for lubrication to reduce the friction when lung tissues move.
What is normal pressure in the pleural space?
✓~ Negative pressure
Closed pneumothorax
✓~ No external wound. Air from internal puncture or tear in the respiratory structure
(emphysema blebs rupture; insertion of subclavian catheter; injury from mechanical
ventilator).
Treatment for closed pneumothorax
✓~ Depends on cause. Minimal air may resolve on its own. Minimal air/fluid can be
aspirated (thoracentesis). Insertion of chest tube connected to water-seal drainage.
Open pneumothorax
✓~ External chest wound.
Aka "sucking" chest wound, when air enters pleural space through chest wall
during inspiration.
Seal open wound, occlusive dressing, sealed on 3 sides.
, What does a dressing sealed on 3 sides do?
✓~ During inspiration, as negative pressure is created in the chest, the dressing pulls
against the wound preventing air from entering pleural space. During expiration as
pressure rises in pleural space, the dressing is pushed out and air escapes through the
wound and from under the dressing.
Tension pneumothorax definition and tx
✓~ Air moves into the pleural space and cant get out. Can occur with open or closed
pneumo.
Tx: Insert large bore needle into anterior chest wall at 4th or 5th intercostal
space to release trapped air. Chest tube inserted and connected to water-seal
drainage. Support oxygen
What does a tension pneumothorax cause?
✓~ Compression of the lung on the affected side puts pressure on heart and great
vessels pushing them away from affected side, compressing other lung. Pressure
increases and venous return is decreased and CO falls. Muffled heart sounds occur,
neck vein distention.
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