Blue Boxes

Question 1

How/Why is a chest tube inserted?

Answer 1

When major amounts if blood, serous fluid, pus or a combo of these accumulate into the pleural cavity a chest tube may need to be inserted

-incision at the 5th/6th intercostal spaces on the midaxillary line (nipple level)

-tube can be inserted superiorly for air removal (toward cervical pleura)

-tube can be inserted inferiorly for fluid drainage (toward costodiaphragmatic recess)

-tube is connected to underwater drainage system with controlled suction to prevent air from being sucked back into the pleural cavity

Removal or air=reinflation of collapsed lung

Failure to remove fluid=resistant fibrous covering which inhibits expansion unless peeled off (lung decortication)

Question 2

What is cardiac tamponade?

Answer 2

Extensive pericardial serous fluid will not allow for the heart to fully expand, limiting the amount of blood the heart can receive and lowering cardiac output
*heart compression can be lethal

-hemopericardium: blood in pericardial cavity often produces cardiac tamponade, usually caused by weakened heart muscle from an MI, after cardiac operations, or stab wounds

-Veins in the face and neck become engorged because of the backup of bloodflow where the SVC enters the pericardium

Question 3

What is pneumopericardium?

Answer 3

If patient has a pneumothorax, the air or gas in the pleural cavity can travel into the pericardial along connective tissue planes and cause compression of the heart

Question 4

What is coarctation of the aorta?

Answer 4

The arch of the aorta or thoracic aorta has an abnormal narrowing/stenosis diminishing the amount of blood flow to the inferior part of the body
*most common site=ligamentum arteriosum
if in this area, compatible with many years of life because of collateral circulation of the intercostal/internal thoracic arteries (may become so large they cause notable pulsation due to compensation)

Question 5

What is Sciatica?

Answer 5

Pain radiating from the lower back into the buttock and down the posterior/lateral aspect of the thigh into the leg (caused by herniated lumbar IV disc that compresses L5 of S1 component of sciatic nerve)

Question 6

What could cause herniation of cervical discs?

Answer 6

Any sport or activity that causes downward or twisting pressure on the neck or lower back

Question 7

What happens in a rupture of the transverse ligament of atlas?

Answer 7

The dens of the axis is set free and causes an incomplete dislocation of the mediam atlanto-axial joint
-Dislocation will have a greater risk of spinal cord compression resulting from fracture of the dens

*this can also be caused by softening of the transverse and adjacent ligaments by disorders of the connective tissue

20% of people with down syndrome will exhibit laxity or agenesis of this ligament