105 - Pleurisy Flashcards
What is pleurisy?
Inflammation of the pleura - due to pneumonia or lung disease
What management options are there for a pneumothorax?
Allow spontaneous resorption Needle Aspiration Chest drain Surgery - talc pleurodesis, pleurectomy Endobronchial valve
What are the 2 types of tension pneumothorax?
+ve pressure ventilation - air can’t escape from the pleura, but more air is forced in on inspiration - gets bigger
Flap valve, air is brought in through trauma wound but the flaps shut on expiration trapping air
What is the management of a tension pneumothorax?
Immediate - 100% high flow 02
Needle thoracocentesis - 2nd ICS, mid clavicular line, hear hiss, then drain
What is the key sign on a Xray of a pleural effusion?
Blunting of the costaphrenic angle
What investigations would you do for a pleural effusion?
Chest X ray
Ultrasound
Aspiration
What are the 2 classes of fluid that come out of an aspiration of a pleural effusion
Transudate - Less than 30 protien - due to organ failures
Exudate - More than 30 protein. Acidic - Ph <7.2. Cloudy. Due to cancer, TB, inflammation, trauma, PE..
Where is turbulent air flow?
Trachea
Where is transitional air flow?
Bronchial tree
Where is laminar air flow?
In the broncioles
How do you measure dead space in the resp system?
Bohr equation
or Fowlers method (estimate anatomical dead space)
How is pulmonary vascular resistance changed?
Passively - recruitment of collapsed vessels, distension of existing vessels.
Actively - HPV - Hypoxic pulmonary vasocontriction - alveolar hypoxia contricts the small pulmonary arteries, which is used a birth and to direct blood away from diseased lung
- Pulmonary vascular resistance - normally very small, decreases on exercise, increases in hypoxia, increases in high + low lung volumes
Where is there the most resistance in the airways?
Half in nasopharynx
Where is there the most resistance in the lungs?
90% in the central airways - bronchi
10% in peripheral airways
What causes the biggest effect on FEV1:FVC when it narrows?
Median sized airways - bronchi