100. Year 4 week 1 podcasts- Pneumothorax Flashcards
How do you read a chest x-ray?
Correct patient?
Rotation, inspiraition, projection/penetration, exposure
A- Airway B- Breathing C- Cardiac D- Diaphragm E- Exposure
What is meant by rotation?
Was the x ray taken at a perpendicular level or is there some rotation? look at distance of clavicle to spinous process
What is meant by inspiration?
Can you see apices, costophrenic angles and first 6 ribs
What is meant by projection?
What is meant by exposure?
Typically PA- if not scapulae it is PA
Is the chest x-ray been captured at the right exposure (too bright or too dark)
What is surgical emphysema?
Air that is under the skin in places it shouldn’t be (e.g. fascia)
typically occurs due to pneumothrax and chest tube but can also occur in surgical procedures or trauma
What is involved in the airway assessment of a chest x-ray?
Tracheal deviation- and what is causing it
Hilum- look for asymmetries or lymph nodes present that shouldn’t be
What is involved in the breathing assessment of a chest x- ray?
Look at the lungs and compare them in three zones (upper, middle, lower)
Look for the pleura (make sure lung margins reach the edge of the frame) Thickening may be mesothelioma
What is involved in the cardiac aspect of assessing a chest x-ray
Assess heart size (not on AP) if it exceeds 50% then cardiomegaly is present
What is involved when looking at the diaphragm during a chest x-ray
look for righ hemidiaphragm lying higher than left, presence of gastric bubble and absence of costodiaphragmatic bubble on the left (bowel perf)
Presence of costophrenic angles
What is involved in everything else?
Bones- rib fractures, lesions
Lines, pacemakers, tubes
How does a pneumothorax manifest on a chest x ray
A well defined lung edge, beyond which no lung markings can be identified
How do you look for a pneumothorax on a chest x-ray?
Follow the neurovascular bundles until they reach and edge. Should go all the way or nearly to chest wall.
How do you determine from chest x-ray whether it is a tension pneumothorax
mediastial shift to the other side or
hemidiaphragm may be squashed
Why is a tension pneumothorax dangerous?
May cause cardiopulmonary collapse
What can cause a pneumothorax?
Spontaneous- primary (young) secondary (underlying)
Traumatic- rib fracture, stab, guns
Iatrogenic-biospy, central line,
