Hemo/pneumothorax Flashcards
Essentials of Diagnosis for Hemothorax
Decreased breath sounds, dullness to percussion on affected side. Respiratory distress and hypotension.
Physical findings for what?
(a) Respiratory distress, tachypnea, variable degrees of hypoxia.
(b) Dullness to percussion, decreased breath sounds on affected side.
(c) Hypotension and flattened neck veins depending on degree of blood loss.
(d) Pulse pressure narrow.
(e) Smaller illnesses may be difficult to detect in supine patients because of gravity.
Hemothorax
Diagnosis confirmed by_____. Volumes of blood as low as ______ may be seen on upright of this imaging modality.
chest X-ray
200- 300mL
What can be used to evaluate for hemothorax at bedside quickly
Ultrasound
DDx for hemothorax
Must consider causes of chest pain and dyspnea
(a) Cardiac
(b) Pulmonary
(c) Trauma
(d) GI
(e) Musculoskeletal
(f) Psych
Tx for Hemothorax
(a) Ensure patient has an intact airway.
(b) Oxygen to correct hypoxia.
(c) If the airway is not intact, provide suctioning and intubation if necessary.
(d) Tube thoracotomy with a 36 or 40 French chest tube.
Disposition of hemothorax
MEDEVAC
Essentials of Diagnosis for Pneumothorax
Absent or decreased breath sounds, hyper resonance to percussion on affected side
_______ is the abnormal collection of air within the pleural space
Pneumothorax
Pneumothorax is classified as what?
spontaneous (primary or secondary)
traumatic (chest trauma or iatrogenic)
_______ pneumothorax occurs in patients without clinically apparent lung disease
Primary spontaneous
Pneumothorax
Typically, young, tall, men age 20-40 who smoke? It is thought to occur from ______
rupture of subapical blebs.
_________ pneumothorax occurs as a complication of preexisting underlying
pulmonary disease.
Secondary pneumothorax
Secondary pneumothorax what is the possible underlying causes
1) COPD
2) Pneumonia
3) CF
4) Asthma
5) TB
6) Pneumocystis carina pneumonia infection.
WHAT must always be considered in trauma patients.
Traumatic pneumothorax is common
would you consider Traumatic pneumothorax as a complication in some invasive procedures
a) Subclavian line placement
b) Thoracentesis
c) Lung or pleural biopsies.
d) Barotrauma from positive pressure ventilation.
yes
These are PE for What?
(a) Pleuritic chest pain, tachypnea, tachycardia.
(b) Chest pain ranging from minimal to severe and dyspnea occur in almost all patients.
Pneumothorax
In small pneumothorax (15% of one Hemothorax or less) physical findings may be _______.
minimal
In a larger pneumothorax what would be some physical findings
diminished breath sounds
decreased tactile fremitus
decreased chest movement
hyper resonance on affected side
_____ imaging will reveal most pneumothoraces
Chest X-ray
Demonstration of a visceral pleural line is diagnostic, may only be seen on an (expiratory/Inspiratory) film.
Expiratory
DDX for pneumonia
Must consider causes of chest pain and dyspnea
(a) Cardiac
(b) Pulmonary
(c) Trauma
(d) GI
(e) Musculoskeletal
(f) Psych
Tx for Pneumothorax
Ensure patient has an intact airway. If the airway is not intact, provide ______ and _____ if necessary.
suctioning
intubation
True/false
Treatment depends on size of the pneumothorax and the patient’s stability
True
Stable or unstable?
1) RR <24/min, HR 60-120/min, BP normal, O2 Sat >90%.
2) Able to speak in sentences.
3) Obtain chest X-ray in 3-6 hours and compare with arrival Chest X-ray.
Stable
Tx for pneumothorax
Ensure intact airway
-If the airway is not intact, provide suctioning and
intubation if necessary
O2
For a large pneumothorax or unstable patients, re-expansion of the lung is necessary
-Chest tube
Treat symptomatically for cough and chest pain
Disposition for pneumothorax
MEDEVAC
What is a complication for pneumothorax
Tension pneumothorax
