Class Notes Flashcards
Stenocardial and pleuritic is found
Pulmonary embolism
How does pleuritic chest pain feel
Sharp stabbing chest pain
What does dull chest pain indicate
Stenocardial
Side effect of an SSRI
Pulmonary hypertension
Types of pneumothorax
Tension
Iatrogenic
Spontaneous
Types of spontaneous pneumothorax
Primary and secondary
What is the difference between primary spontaneous pneumothorax and secondary
Primary is without lung disease present aspiration is enough, while in secondary lung disease is present such as COPD and cystic fibrosis
What can happen in tension pneumothorax
Due to shot wound, air will move to the plural space and increase pressure and mediastinum will shift to the opposite side and can obstruct great vessels
Which type of pneumothorax is considered a medical emergency
Tension pneumothorax
Treatment of tension pneumothorax
Place a catheter or a drainage in to the 2nd intercostal space
What is considered a big pneumothorax
Later of air bigger than 2CM
What is done in a big pneumothorax
Drainage
What is considered a small pneumothorax
Smaller than 2CM can happen if a catheter is placed in the the plural space
What is done in case of small pneumothorax
If there are no symptoms just give O2 and wait (conservative treatment)
What is done in secondary pneumothorax
Chest drainage is needed
Where to place chest drainage
Safe triangle
Where to place aspiration
2nd intercostal space
How do we insert anything through the chest
We go over the rib and we use local anaesthesia since below the rib there’s artery vein nerve
When is X-ray preformed for pneumothorax
On diagnosis, after 6 hours and after 24 hours
What is the conservative treatment for pneumothorax
Wait observe and give O2
What is pleurodesis
Injecting tetracycline, iodine, belomycin, talk or tissue glues which causes inflammation and cause the pleura to stick
Indications of pleurodesis
- Primary spontaneous pneumothorax drained for more than 5-7 days
- Secondary spontaneous pneumothorax
- to prevent recurrent pneumothorax and plural effusions
Main complications of pleurodesis
Painful - give lidocaine intrapleurally, painkillers or opioids
What is a plural effusion
Fluid in the pleural cavity which can be transudate or exudate based on (lights criteria)
What can cause a transudate pleural effusion
Heart failure
Liver failure
Nephrotic syndrome….
Less than 0.5 protein and 0.6 LDH
What is lights criteria
If the fluid has
protein ratio over >0.5
LDH serum LDH>0.6
Pleural fluid LDH>2/3 ofULN serum LDH
Then it is an exudate and further tests are required
If not then it is a transudate and no further tests are required
What can cause exudate pleural effusion
Infection Neoplasm Immunological disease Pneumonia TB More than 0.5 protein and 0.6 LDH
When is it more common to be needed to evacuate the fluid
If it’s an exudate since symptoms start showing up
What is done in case of malignancy and pleural exudate
Pleurodesis because it will probably relapse
What is done after identifying a pleural exudate
We need to find the underlying disease and treat it
What indicates an immediate chest drainage
Pleural fluid of PH lower than 7.2
What can effusions rich in lymphocytes be caused by
Malignancy, TH, lymphoma, heart failure, rheumatoid arthritis or chylothorax
What could effusion rich in eosinophils be caused by
Pneumothorax
What is chylothorax
(Rare cause of pleural effusion) yellow millet liquid, rich in triglycerides more than 1.24 mmol/L
What is empyma
Infected fluid in pleural cavity and is and indication for chest drainage and in some cases is treated surgically
How does empyma look
Thick yellow green pus
What is hemothorax
The hematocrit is over 50% of peripheral blood
It could be misleading in cases of empeyema and malignancy causes effusion so we need to find hematocrit percentage
What should be done in the case of a hemothorax and why
We need to drain it (CHEST DRAINAGE)
High risk of empyma development and can lead to fibrothorax
