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34 Cards in this Set
- Front
- Back
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what is the primary etiology behind a spontaneous pneumothorax?
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most common due to rupture of Blebs or Bullae (Congenital) into the pleural space
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what type of pt is going to get a spontaneous pneumothorax?
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85% of patients < 40 years of age
Tall, thin, cigarette smoking male Other risk factors: smoking, family history, Marfans syndrome, homocystinuria, and thoracic endometriosis. |
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what are some of the 2ndary causes of spontaneous pneumothorax? (there are 7, just be able to recognize the general theme of these)
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1. obstructive airway disease (emphysema, asthma,)
2. infection (cavitating pneumonia, lung abscess, septic emboli, pneumatocele, pneumocystis carinii pneumonia) 3. pulmonary infarction 4. tumors (primary & metastatic) 5. cystic lung disease (sarcoidosis, cystic fibrosis, tuberous sclerosis) 6. catamenial (occurs 24-72 hours after the onset of menses) 7. connective tissue disorders (Marfans, Ehler-Danlos) |
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what is percutaneous intervention and what problem can it lead to?
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it is when you have to do some type of work/procedure
it can lead to traumatic lung collapse |
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Central line, Thoracentesis, Transthoracic Lung or Pleural Biopsy can lead to what 2ndary problem?
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lung collapse
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what is meant by iatrogenic?
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you caused the problem (aka the doc/procedure)
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a young thin male cigarette smoking pt has sudden onset of ipsilateral chest pain and dyspnea, and heavy exertion. The pt states the problems began several days ago. What do they have?
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spontaneous pneumothorax
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the following are symptoms of what? (more just to read and recognize)
Decreased chest excursion on the affected side Decreased breath sounds on the involved side Decreased tactile fremitus Hyperresonance to percussion Tachycardia Tachypnea Subcutaneous emphysema may be present |
pneumothorax
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what are the ABCDEs?
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Airway maintenance and C-spine stabilization;
Breathing; Circulation with control of massive hemorrhage; Disability (mental status); and Exposure -- undress the patient. |
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what will give a 6 fold increase in resolution time for a pneumothorax?
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may increase 6 fold if humidified 100% oxygen is administered
normally will resolve at 1.25%/day |
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if you have 5 days failure of re-expansion of a collapse lung, what do you want to do?
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thoracoscopy or open thoracotomy
Tx: bleb resection & parietal pleural abrasion, chemical pleurodesis (Doxycycline, Talc) |
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we have hammered home that The peak incidence of idiopathic spontaneous pneumothorax is in persons between 20 and 30 years of age; the male-to-female ratio is approximately 5:1. Patients often have a tall, thin stature and very frequently are cigarette smokers (think this is important?)
Ok, so these pt's are generally healthy, what is the underlying thing leading to the pneumothorax? *** |
most have subpleural apical blebs, frequently associated with more diffuse centrilobular emphysema that is detectable by CT scan
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when do symptoms of pneumothorax (spontaneous) occur?
A)airplane travel B)Playing basketball, physical strenuous activity C) At rest, watching some TV D)Swimming laps in a pool *** |
In fact, most studies have found that the onset of symptoms of pneumothorax usually occurs at rest or during light activity.
so C) At rest, watching some TV, is the best choice |
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putting a needle in, above or below the rib?
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above
don't want to hit neurovascular bundle |
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A 21-year-old white man is admitted to the hospital. The patient reports that while jogging earlier that day, he developed acute left anterior chest pain that was significantly worsened by deep inspiration. His pain radiated to his left shoulder. He also developed moderate shortness of breath. He denies having any fever or chills; he has not experienced any recent immobility, and he has no personal or family history of clotting disorders. The patient has smoked one pack of cigarettes a day for the past 3 years. A chest x-ray is normal except for a large left pneumothorax. Which of the following statements regarding idiopathic spontaneous pneumothorax is true?
A) The peak incidence occurs in persons between 30 and 50 years of age; there is a strong female preponderance B) Patients are often tall and thin in stature and are often cigarette smokers C) Most patients with idiopathic spontaneous pneumothorax have subpleural basilar blebs D) Strenuous physical activity and airplane travel are frequent triggers for the development of idiopathic spontaneous pneumothorax |
B) Patients are often tall and thin in stature and are often cigarette smokers
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hemothorax vs pneumothorax:
percussion sound |
hemo: dull
pneumo: tympanic |
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pt presents with Dyspnea
Decreased Breath sounds Dullness to percussion on affected side what do they have? |
hemothorax
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if there is evidence that shows there is fluid in the lung, what should you do FIRST?
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put in a central line (Large bore intravenous access for rapid fluid resuscitation)
if you put your chest tube in first, it will be really friggin hard to put in a central line after |
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what is the big reason people die in hemothorax?
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diminished venous return
in superior or inferior vena cava & compromises cardiopulmonary function |
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the most common site of aortic transection is at the...??
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ligamentum arteriosum just distal to the left subclavian artery
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what is the first study you do to test for cardiac tamponade
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by ultrasound as the first study of the standard FAST (Focused Assessment with Sonography for Trauma) examination can be performed in the ED to rule out or diagnose tamponade, pneumothorax or hemothorax
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CC: Dyspnea, Orthopnea, Fatigue, Interscapular pain
Physical: Hypotension, JVD, Pulsus paradoxus (95% > 10mm Hg. decreased SBP during inspiration, decreased pulse amplitude during inspiration) also have distant heart sounds..what do they have? |
Cardiac Tamponade
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what is beck's triad, and what is it found in?
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Muffled heart sounds (pericardial friction rub - occasionally)
Hypotension Distended Neck Veins seen in cardiac tamponade |
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Mechanism of Pleural Fluid Accumulation:
Increased hydrostatic pressure What is going on? **** |
CHF
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Mechanism of Pleural Fluid Accumulation:
Decreased oncotic pressure What is going on? **** |
Nephrotic Syndrome
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BLOOD EFFUSIONS OFTEN DENOTE WHAT?
****TESSSSSSSTTT |
Malignancy
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Mechanism of Pleural Fluid Accumulation:
Increased permeability What is going on? **** |
-Inflammation
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Mechanism of Pleural Fluid Accumulation:
Impaired lymphatic drainage What is going on? **** |
Malignancy
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Mechanism of Pleural Fluid Accumulation:
Communication with peritoneal space What is going on? **** |
Ascites
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Diagnostic thoracentesis yields 60 ml of milky white fluid.....this is seen in what?
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Chylothorax
(lymphatics damaged) |
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most common cause of chylothorax?
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malignancy
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what is the second leading cause of chylothorax?
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trauma
remember: malignancy is the leading cause note: Idiopathic Chylothorax and miscellaneous causes account for the remaining two categories. |
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what is empyema and what are the 2 forms?
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plueral effusion (pus) due to infection
Aerobic- acute febrile illness, chest pain, sputum production, elevated WBC. (Strep. Pneumo has a rapid course) Anaerobic- subacute illness, more common in alcoholics, unconsciousness, aspiration |
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what are the 4 T's for the differential diagnosis of mediastinal masses?
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Thymoma
Teratoma Thyroid (Enlarged) Terrible Lymphoma |
