Chest xrays

Question 1

features of a flail chest

Answer 1

features of respi distress
paradoxical movement of flail segment
papable creps of ribs
decreased air entry on affected side

Question 2

mx of flail chest

Answer 2

oxygen pain control(epidural anesthesia w rib block in intercostal nerve bundle)
judicious fluid therapy 
positive pressure ventilation
intubation and ventilation
chest physio 
operative fixation of ribs

Question 3

what causes patients with a flail chest to develop respi distress

Answer 3

underlying lung contusion from break in 2 or more adjacent ribs each at two sites

Question 4

mx of a open pneumothorax/sucking chest wound

Answer 4

occlusive dressing sealed on THREE sides to allow air entry and collapse

Question 5

what is a pneumoperitoneum

Answer 5

presence of air in peritoneal cavity

Question 6

most common cause overall of pneumoperitoneum and most common pathological cause

Answer 6

overall: post laporascopic sx

pathological: perforated ulcer(less common since ppi)
diverticular disease

stab injury common as well

Question 7

how do pts with pneumoperitoneum present

Answer 7

excruciating pain
abd distention
vital signs suggestive of dehydration
rigid abd with rebound

Question 8

tx of pneumoperitoneum

Answer 8

resus- iv fluids plus ngtube plus ucath( resus in 3-4 hours)
analgesia

after watch patient and see if theatre needed however omentum may seal off so may not see anything but if in theatre already remove omentum and perform graham patch then discharge on triple therapy

Question 9

side effect of bismuth in quadruple therapy

Answer 9

black stool dark urine

Question 10

how do u tell whether a FB is in trachea or esophagus

Answer 10

in trachea u will not see radiolucency behind fb

in esophagus u will see radiolucency of trachea behind fb

Question 11

how would u treat a fb detected for eg a coin stuck

Answer 11

rigid esophagascope to grasp FB and retrieve same