Hemo/pneumothorax

Question 1

Essentials of Diagnosis for Hemothorax

Answer 1

Decreased breath sounds, dullness to percussion on affected side. Respiratory distress and hypotension.

Question 2

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.

Answer 2

Hemothorax

Question 3

Diagnosis confirmed by_____. Volumes of blood as low as ______ may be seen on upright of this imaging modality.

Answer 3

chest X-ray
200- 300mL

Question 4

What can be used to evaluate for hemothorax at bedside quickly

Answer 4

Ultrasound

Question 5

DDx for hemothorax
Must consider causes of chest pain and dyspnea

Answer 5

(a) Cardiac
(b) Pulmonary
(c) Trauma
(d) GI
(e) Musculoskeletal
(f) Psych

Question 6

Tx for Hemothorax

Answer 6

(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.

Question 7

Disposition of hemothorax

Answer 7

MEDEVAC

Question 8

Essentials of Diagnosis for Pneumothorax

Answer 8

Absent or decreased breath sounds, hyper resonance to percussion on affected side

Question 9

_______ is the abnormal collection of air within the pleural space

Answer 9

Pneumothorax

Question 10

Pneumothorax is classified as what?

Answer 10

spontaneous (primary or secondary)
traumatic (chest trauma or iatrogenic)

Question 11

_______ pneumothorax occurs in patients without clinically apparent lung disease

Answer 11

Primary spontaneous

Question 12

Pneumothorax
Typically, young, tall, men age 20-40 who smoke? It is thought to occur from ______

Answer 12

rupture of subapical blebs.

Question 13

_________ pneumothorax occurs as a complication of preexisting underlying
pulmonary disease.

Answer 13

Secondary pneumothorax

Question 14

Secondary pneumothorax what is the possible underlying causes

Answer 14

1) COPD
2) Pneumonia
3) CF
4) Asthma
5) TB
6) Pneumocystis carina pneumonia infection.

Question 15

WHAT must always be considered in trauma patients.

Answer 15

Traumatic pneumothorax is common

Question 16

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.

Answer 16

yes

Question 17

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.

Answer 17

Pneumothorax

Question 18

In small pneumothorax (15% of one Hemothorax or less) physical findings may be _______.

Answer 18

minimal

Question 19

In a larger pneumothorax what would be some physical findings

Answer 19

diminished breath sounds
decreased tactile fremitus
decreased chest movement
hyper resonance on affected side

Question 20

_____ imaging will reveal most pneumothoraces

Answer 20

Chest X-ray

Question 21

Demonstration of a visceral pleural line is diagnostic, may only be seen on an (expiratory/Inspiratory) film.

Answer 21

Expiratory

Question 22

DDX for pneumonia
Must consider causes of chest pain and dyspnea

Answer 22

(a) Cardiac
(b) Pulmonary
(c) Trauma
(d) GI
(e) Musculoskeletal
(f) Psych

Question 23

Tx for Pneumothorax
Ensure patient has an intact airway. If the airway is not intact, provide ______ and _____ if necessary.

Answer 23

suctioning
intubation

Question 24

True/false
Treatment depends on size of the pneumothorax and the patient’s stability

Answer 24

True

Question 25

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.

Answer 25

Stable

Question 26

Tx for pneumothorax

Answer 26

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

Question 27

Disposition for pneumothorax

Answer 27

MEDEVAC

Question 28

What is a complication for pneumothorax

Answer 28

Tension pneumothorax