Week 1 - complications, signs, treatments
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| What is a pneumothorax? | The partial or complete collapse of the lung due to air entering the pleural space and compressing the lung
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| When does a primary pneumothorax occur? | Without an apparent cause
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| When does a secondary pneumothorax occur? | In the presence of an existing lung pathology eg COPD, lung cancer
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| What is a tension pneumothorax? | When a pneumothorax leads to significant impairment of respiration and/or blood circulation. Tends to occur in clinical situations such as ventilation, resuscitation, trauma, or in patients with lung disease
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| What does iatrogenic mean? | Following a medical procedure
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| What is a traumatic pneumothorax? | Most commonly occurs when chest wall is pierced e.g. stab/gunshot would allowing air to enter
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| What are some signs and symptoms of a pneumothorax? | Chest pain and sometimes mild breathlessness may indicate PSPs. Hypoxemia, cyanosis and hypercapnia may indicate SSPs. Breath sounds may be diminished on the affected side
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| If there is a pneumothorax, how does this effect percussion? | Percussion of the chest may be hyperresonant (sound of a drum or puffed up cheeks)
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| What happens to tactile fremitus if there is a pneumothorax? | It is decreased or absent over areas of pneumothorax
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| What are some risk factors of a primary spontaneous pneumothorax? | Male, smoking, tall and thin, family history
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| What might cause primary pneumothorax? | Blebs (small air-filled lesions just under the pleural surface)
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| What might cause a traumatic pneumothorax? | A blunt trauma, penetrating injury to the chest, or medical procedures such as inserting a catheter into a chest vein, or taking a biopsy
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| When might a tension pneumothorax occur? | When the opening that allows air to enter the pleural space functions as a one-way valve, so more air enters than leaves. The body compensates by increasing the respiratory rate and tidal volume, worsening the problem
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| How is a diagnosis of a pneumothorax confirmed? | -Confirmed with medical imaging
-A chest radiograph (usually PA)
-CT scan
-An ultrasound
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| How is a traumatic pneumothorax treated? | -A chest tube is usually inserted
-An asherman seal is an air-tight seal that is used to cover the wound
-A pleurodesis can b
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| How is a tension pneumothorax usually treated? | Urgent needle decompression
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| What is pleurodesis? | A procedure which totally removes the pleural space and attaches lung to chest wall
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| What can cause deviation of the trachea towards the diseased side? | -Atelectasis
-Agenesis of lung
-Pneumonectomy
-Pleural fibrosis
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| What can cause deviation of the trachea away from the diseased side? | -Pneumothorax (more common in a tension pneumothorax)
-Pleural effusion
-Large mass
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| What is the mediastinum? | A group of structures in the thorax surrounded by loose connective tissue. it is the central compartment of the thoracic cavity. It contains the heart, oesophagus, trachea, phrenic nerve, cardiac nerve, thoracic duct, thymus, lymph nodes of central chest
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| Where does the trachea lie in most people? | In the middle of the neck, but in most people it lies slightly to the right
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| How can the trachea be palpated? | By placing a finger on the suprasternal notch with the head facing anteriorly. Deeper palpation should allow you to feel the trachea. (Uncomfortable, but not painful)
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| What are common signs and symptoms of tracheal deviation? | -Difficulty breathing (dyspnea)
-Cough
-Abnormal breathing sound
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| What causes engorged veins? | Mediastinal shift can obstruct venous return. The veins are often compressed or constricted which results in poor venous blood flow
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| What are the 5 methods of examination? | Percussion, inspection, palpation, auscultation, and smell
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| What is percussion? | A method of tapping on a surface to determine the underlying structure, and is used in clinical examinations to asses the condition of the thorax or abdomen
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| How is percussion carried out? | The middle finger of one hand tapping on the middle finger of the other hand using a wrist action. The non-striking finger (pleximeter) is placed firmly on the body over tissue
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| What are the two types of percussion? | Direct (uses one or two fingers) and Indirect (uses the middle/flexor finger)
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| What are the four types of percussion sounds? | Resonant, hyper-resonant, dull and strong dull
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| What does a dull sound when percussing indicate? | A solid mass under the surface
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| What does a more resonant sound when percussing indicate? | Hollow, air-containing structures
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| What is percussion of the thorax used to diagnose? | Pneumothorax, emphysema, and other diseases
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| What is percussion of the abdomen used to diagnose? | To find out if an organ is enlarged and similar, or if it's healthy or pathological
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| What are the different notes that can be heard in percussion? | Tympanic (drum-like, over air filled structures)
Hyperresonant (pneumothorax- sounds like percussion of puffed up cheeks)
Normal resonance (normal chest)
Impaired resonance (mass - lower than normal)
Dull (Similar to percussion of a mass)
Strong dull
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| What is auscultation? | Listening to the internal sounds of the body, usually by a stethoscope
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| What is immediate auscultation? | Listening to sounds of the body directly, placing an ear on the body
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| What is mediate auscultation? | Listening to the internal sounds of the body using an instrument e.g. a stethoscope
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| What is Doppler auscultation? | Enables the auscultation of valve movements and blood flow sounds that are undetected using a stethoscope during the cardiac exam of an adult
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| What are vesicular (normal) breath sounds? | Soft and low pitched, with a rustling quality, during inspiration, and an even softer quality during expiration. They have an inspiration/expiration ration of 3:1
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| In what direction are chest exams usually taken and why? | Posterior-anterior because they often give a clearer picture, as they don't have the heart, bones, and other structures from getting in the way
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| When might an anterior-posterior radiograph be taken? | Carried out if the patient is too unwell to sit up, or in cases of trauma
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| What is a normal chest radiograph? | The lung reaches the inner edge of the thoracic wall. The two lungs meet in the middle at the posterior junctional line and the anterior junctional line
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| What is does a pneumothorax chest radiograph look like? | The lung is completely covered, the trachea is often displaced to the opposite side, the heart is often shifted to the opposite side, the hemidiaphragm of the lung is depressed
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| When is a pneumothorax classed as large? | Consists of a rim of air outside the lung greater than 2cm wide on a chest x-ray
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| Why might a pneumothorax be difficult to diagnose on a radiograph? | They are often oblique lines which are difficult to see
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| What is looked for in a CXR? | Airway, Breathing and bones, Cardiac, Diaphragm, Everything else
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| Where can a chest drain be safely inserted? | 2nd intercostal space in the mid-clavicular line (not usually recommended)
5th intercostal space in the mid-axillary line (may be uncomfortable)
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| Where are chest drains inserted? | Into the pleural space
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| Outline the method of inserting a chest drain | -Area numbed and cleaned
- 1 inch cut in the skin between ribs, and guided to the correct spot
-Tube is connected to a bottle or canister
-A suture and tape is used to keep the drain in place
-Suction or gravity is used to help it drain
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| What do bubbles indicate if the tube of the chest drain is put in water? | Bubbles initially show the air draining out of the lungs. Continued bubbles may indicate a bigger hole
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| What happens when the water level of the chest drain rise and fall? | With normal breathing
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| What technique is often used to insert a chest drain? | Seldinger technique
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| What is a suture? | A surgical stitch used to hold tissues together
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