Lecture 28 Flashcards
What is the standard protocol for chest radiography?
the PA view is the standard view. the film is infront and the camera/xray is on the back of the person.
How is the positioning of an AP radiograph?
the person is laying down and the film is on the back of the patient while the camera faces the front of the patient. This is down when PA view cannot be done and the patient has an issue with positioning or you need the images stat.
how is a lateral chest radiograph taken?
lateral views are taken to the side with arms up
describe the thoracic cavity
- space found in the upper trunk
- separated form the abdominal cavity by the diaphragm
- protected externally by ribs and muscles
- house important organs ( heart, lung, esophagus)
- contains the mediastinum and three serous cavities.
- two pleural cavities
- one pericardial cavity
describe the pleural cavity
-closed cavities surrounding the lungs
- lined by serous membranes-
Parietal and visceral pleura
what lines the left and right pulmonary cavities, separated by the mediastinum?
lined with parietal pleura that reflects onto the lungs as visceral pleura
where is the costomediastinal recess?
between costal and mediastinal pleura
LOOOK AT PIC
where is the costodiaphragmatic recess?
between costal and diaphragmatic pleura
LOOK AT PIC
to find the costodiaphragmatic recess at the midclavicular line while exhaled what location would you insert a needle?
- Inferior border of lung at rib 6
- Inferior edge of parietal pleura rib 8
to find the costodiaphragmatic recess at the mid- axillary line what location would you insert a needle?
- Inferior border of lung at Rib 8
- inferior edge of parietal pleura rib 10
to find the costodiaphragmatic recess at the paravertebral location where would you insert a needle?
Inferior border of lung TV10 and inferior edge of parietal pleura TV12
What is a pneumothorax?
presence of air in the pleural cavity
what would cause a spontaneous pneumothorax/
absence of lung disease, no prior event that provokes it, ruptured of blebbed bullae
what would cause a traumatic pneumothorax?
introduction of air in the pleural cavity secondary injury to pleura/ blunt or penetrating trauma
other causes: inflammation, smoking, underlying pulmonary disease
what is the difference between a tension and a non-tension pneumothorax?
non tension: there is no valve mechanism ( unsealed opening) so there is no build up of pressure
tension pneumothorax: the air filling the pleural cavity cannot escape ( forming a one way valve). The visceral pleura are ruptured in this condition. The pressure in the pleural cavity builds up with every breath causing a mediastinal shift. this leads to severe shortness of breath, and circulatory collapse.
What are the signs and symptoms of a tension pneumothorax?
displacement of mediastinum causing cardiopulmonary disfunction.
flap valve present
compression of heart and great vessels
dyspnea, chest pain, tracheal deviation, hypotension, neck vein distention, hyper resonance.
To do a needle decompression on a patient with a tension pnemothorax, what is done?
it is inserted in the 2nd intercostal space in mid-clavicular line in affected hemithorax.
need a large bore needle 14/16 gauge.
To do a tube thoracotomy on a patient because a thoracostomy isn’t possible, where should the needle be inserted??
it relieves trapped collection of air or fluid in the thorax.
location: 4th or 5th intercostal space between the anterior axillary and midaxillary lines.
how to perform endotracheal intubation?
introduce laryngoscope: move tongue forward, expose epiglottis and vocal folds.
Introduction of endotracheal tube:
- advance tube between the vocal folds into the trachea, 2-3 cm above Carina.
aspirate to remove excess secretions.
