Case 1: Acute Breathlessness Flashcards
How could the muscular system cause AB?
Weakness or loss of function of your respiratory muscles through any cause including trauma can result in pain and breathlessness.
How could the Haematological System cause AB?
Anaemia if severe enough reduces your ability to carry oxygen as you due to the reduction in red cells and as a consequence haemoglobin too can result in breathlessness.
How could the nervous System cause AB?
Damage to the brain or the spinal cord, such as multiple sclerosis and Guillain-Barre syndrome, can result in breathlessness.
How could the digestive System cause AB?
Acute GI bleed can lead to severe anaemia and cause breathlessness. Severe Gastrointestinal Reflux Disease (GORD) leading to aspiration can result in breathlessness.
How could the endocrine System cause AB?
For example, both thyrotoxicosis (increases metabolic rate) and hypothyroidism (severe and untreated leads to respiratory muscle weakness) can cause breathlessness.
How could the skeletal System cause AB?
Trauma, if you fracture your ribs for instance, can cause breathlessness and chest pain, and spinal disorders that reduce the ability to expand your lungs (kyphosis, scoliosis) can lead to breathlessness.
pleuritic chest pain
sharp stabbing pain on one side that is worse during inspiration or with certain movement of the chest wall
pneumothorax and AB
Pneumothorax is the presence of abnormal air between the two pleural linings (visceral and pleura) called the pleural space. Normally the pleural space contains very small amounts of pleural fluid. This air leak builds up, thus stretching the pleural lining and presses on the lung to cause it to collapse. As a result, a pneumothorax causes sudden sharp chest pain and breathlessness. Being male, having underlying lung disease and smoking are risk factors for pneumothorax. Pneumothorax can by spontaneous or caused by trauma. If spontaneous it can be primary (no underlying lung disease) or secondary to underlying disease e.g COPD .
pulmonary embolism
PE is an abnormal clot formation (thrombus) in the pulmonary circulation to the lung that results in a reduced blood flow to the region of the lung that the pulmonary artery supplies. This can cause infarction of the lung and leads to breathlessness and pleuritic chest pain. It is sometimes associated with haemoptysis. There may also be calf swelling and other risk factors.
pleurisy
an inflammation of the pleura that produces sharp chest pain with each breath
Viral infection is one of the most common causes of pleurisy. Viruses that have been linked as causative agents include influenza, parainfluenza, coxsackieviruses, respiratory syncytial virus, mumps, cytomegalovirus, adenovirus, Epstein-Barr and now of course corona virus.
primary spontaneous pneumothorax
The classic presentation is that of sudden onset of pleuritic chest pain and dyspnoea at rest. The symptoms do not correlate closely with the size of the pneumothorax [12]. In many cases the symptoms are mild and approximately half of patients will present after more than 2 days of symptoms.
secondary spontaneous pneumothorax
The symptoms are often more severe than those associated with a primary pneumothorax because lung function may already have been compromised by the underlying pathological process. The symptoms will vary depending on the cause e.g. fever, weight loss, night sweats but the primary complaint is that of breathlessness which is often out of proportion to the size of the pneumothorax radiologically.
Unlike symptoms, the examination findings in primary spontaneous pneumothoraces are affected by the size of the pneumothorax. A small pneumothorax can be impossible to identify on clinical examination.
pneumothroax
air in the pleural cavity
traumatic pneumothorax
iatrogenic, baro trauma. non iatrogenic: fall, trauma,
cause of primary PnTx
air leak from apical and subpleural blebs and bullae
bullae
Large blisters
cause of secondary PnTx
lung disease, ^ alveolar pressure, defects in connective tissue
risk factors for pneumothorax
- Smoking
- Pulmonary disease
- Age (20-40)
- Tall, thin, male
- Family hx
- trauma
risk factors for secondary pneumothorax
associated with asthma, cystic fibrosis, pulmonary fibrosis, tuberculosis, acute resp distress, and other lung diseases
Birt Hogg Dube syndrome
Marfans
smoking, cannabis
Homocystinuria
Cystathione synthase deficiency
Lens subluxation, thrombosis, marfanoid, intellectual disabiliity
Tx: pyridoxine
Birt-Hogg-Dube syndrome
Thin-walled oval-shaped lung cysts (looks like LAM)
Bilateral renal oncocytomas, chromophobe RCC
signs of pneumothorax
sudden chest pain with dyspnea, decreased lung sounds/affected side
SOB more severe in 2ndary
hyperinflation
reduced expansions
hyperesonant breath
quiet breath sounds
tachy
subcut empyshema
signs of pneumothorax on x ray
deep sulcus sign
ABGS for pneumothorax
Hypoxia
severity depends on width of the rim of lung in PnTx xray
Small <2cm > large
never clamp a drain for
pntx chest drain
chemical pleurodesis
a chemical is placed into the pleural space to cause inflammation and thereby reduce the effusion of the area
surgical pleurectomy
open thoracotomy
or VATS
causes inflation
tension pneumothorax
a type of pneumothorax in which air that enters the chest cavity is prevented from escaping
signs of tension pneumothorax
progressive shortness of breath, increasing alerted level of consciousness, neck vein distention, tracheal deviation
tension pneumothorax aspiration
14G cannula
2nd IC space, MCline
hiss - protect with gauze, leave it and prepare chest drain
Pneumothorax Pathophysiology
Air in the intrapleural space
- Complete or partial collapse of lung
pleural pressure equals atmospheric presure
- no force to counter elastic recoil
lung collapses
Normal lung expansion cannot take plane
the lung will stay collapsed until puncture sealed
tension Pneumothorax Pathophysiology
injury creates one way valve
air drawn into pleural space
on expiration the air in the pleural space is trapped and c ompressed. this pleural pressure exceeds central venous pressure
causes of PE
DVT.
Previous DVT or PE.
Active cancer.
Recent surgery.
Lower limb trauma.
Significant immobility, for example, due to hospitalisation.
Pregnancy and, in particular, for 6 weeks’ postpartum.
what percentage of leg thrombi will embolise
20%
rare forms of emboli
fat, N bubbles, atherosclerotic debris (cholesterol emboli), tumor fragments, bone marrow, foreign bodies
acute: thromboembolism PE
massive
Chronic thromboembolic PE
repeated small eboli - occlusion
symptoms of PE
sudden-onset dyspnea, chest pain, tachypnea & tachycardia