Chest pain Flashcards
(55 cards)
6 causes of pneumothorax
Spont
chronic lung disease
infection
trauma
carcinoma
connective tissue disorder
What is a primary vs secondary pneumothorax?
Secondary is due to:
- underlying lung disease
- smoker over 50y
What imaging would you do in pneumothorax? How do you measure how big it is?
- none in tension
- otherwise EXPIRATORY CXR
- size of PT is measured at level of hilum
What could be mistaken for a pneumothorax on a cxr?
Large emphysematous bulla
How do you manage a primary pneumothorax?
If not SOB and/or not >2cm on xray- discharge and review in 2-4w.
If SOB and/or >2cm on xray- aspirate, if unsuccessful then chest drain.
Then discharge and review in 2-4w
How long does a chest drain stay in for
24h after re-expansion and bubbling has stopped
How do you manage a secondary pneumothorax?
If sob or >2cm- chest drain
If not SOB and is 1-2cm- aspirate (chest drain if unsuccessful, admit for 24hr of O2 and obs if successful)
If not SOB and <1cm- admit for O2 and 24hr observation
What additional symptoms do you get in a tension pneumothorax?
Tachycardia
Hypotensive
Distended neck veins
How do you manage a tension pneumothorax
Large bore (14-16G) needle and syringe partially filled with 0.9% saline. 5th IC space, anterior axillary line. Remove plunger until a chest drain is inserted.
Sudden tearing chest pain radiating to back?
Thoracic aortic dissection
Which part of the aorta splits in a dissection?
Tunica media
How can thoracic aortic dissection present other than chest pain?
Syncope
What signs might you get in thoracic aortic dissection?
Hemiplegia (carotid)
Unequal arm pulses and BP
Acute limb ischaemia
Paraplegia (anterior spinal artery)
Anuria (renal artery which is from abdominal aorta at L1-2)
What happens if a thoracic aortic dissection moves proximally?
Can get aortic valve incompetence, inferior MI, cardiac arrest
70% thoracic aortic dissections involve the _____ aorta, this is called Type ___
Ascending
A
What is a type B thoracic aortic dissection? How common is it?
Doesn’t involve the ascending aorta
30%
What should you consider in thoracic aortic dissection Type A (ascending aorta involvement)?
surgery
How would you manage a thoracic aortic dissection?
Crossmatch 10U blood
ECG and CXR
CT and/or TO echo
To ICU
IV beta blockers e.g. labetalol/esmolol (v short acting) to reduce LV pressure. Or CCB if contraindicated.
Morphine
Urgent cardiothoracic advice
What might the CXR show in thoracic aortic dissection?
Widened mediastinum
acute operative mortality rate in thoracic aortic dissection?
<25%
ACS can be which 3 things?
Unstable angina, STEMI, NSTEMI
What signs might you hear on examination in ACS?
3rd/4th HS/quiet 1st HS
Pan systolic murmur
Pericardial rub
Basal crackles (pul oedema)
Hypotension and narrow pulse pressure (<40 difference)
Raised JVP
Tachycardia
Pallor, sweaty
What do you need to assess in the history of ACS?
Risk factors including:
cocaine
connective tissue disease
Rheumatic fever
HTN
smoking
High cholesterol
diabetes
VTE risk
(BUT NB these are the risk factors for atherosclerosis, and women are more likely to have vasospastic disease)
Investigations in ACS
12 lead ECG (+cardiac monitor)
Troponin
CXR if it won’t delay Rx
FBC, UandEs, glucose, lipids, cardiac enzymes, ABG
