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.
what fissure on the lungs divides the inferior, middle and superior lobes on the right lung?
the oblique fissure
on the left lung: the oblique fissure also separates the superior and inferior lobes
what lobes does the horizontal fissure on the right lung separate?
middle and superior lobe
what are the surfaces of the lungs?
mediastinal, coastal, diaphragmatic surfaces
what are the borders of the Lungs?
anterior, inferior, posterior
what is the hilum of the lung?
-region where the mediastinal pleura meets the visceral pleura
what is the root of the lung?
- attaches the lung to structures on the mediastinum
- formed by structures entering and leaving the lung
- bronchi
- pulmonary artery ( venous blood)
- pulmonary vein ( arterial blood)
- bronchial arteries
- lymph vessels
- nerves
what are the impression features of the right lung?
Medial surface: Superior vena cava, heart, inferior venacava, azygous vein, esophagus
what are the impression features of the left lung?
Medial surface: heart, aortic arch, thoracic aorta, esophagus
what is the location of the oblique fissure in reference to the back?
begins at the spinous process of the scapula ( TIV) and follows rib VI anteriorly.
SEE PIC
what is the location of the horizontal fissure in reference to body?
follows 4th intercostal space laterally to meet oblique fissure
SEE PIC
describe the bronchial tree
primary( main) bronchus
-to lung
secondary (lobar) bronchus
-to lobe
Tertiary (segmental) bronchus
- to lobe segment
carina is in the middle
aspirated or inhaled foreign objects end up where?
lodge in the wider shorter and more vertical right bronchus and eventually in the right lobe.
what is atelectasis?
obstructed airway,
prevents free passage of air resulting in lung collapse.
collapse is distal to obstruction
symptoms:
difficulty breathing (dyspnea)
coughing
what is the smallest functional unit of the lung?
bronchopulmonary segments
what supplies the bronchopulmonary segments? and what drains them?
tertiary bronchi, and pulmonary veins
what branches follow that of the segmental bronchi? What do those supply blood to?
the branches of the pulmonary artery. pulmonary artery and veins provide blood supply to the visceral pleura.
pulmonary veins leave the lungs in the intersegmental septa
how do pulmonary veins drain?
intersegmentally
how do pulmonary arteries and their branches drain?
segmentally with bronchi
What do bronchial vessels supply?
the bronchial tree and visceral pleura
Left bronchial arteries supply what?
direct branches of the aorta
Right bronchial arteries supplied from
posterior intercoastal
bronchial veins drain where?
into the hemiazygous ( left bronchial) and azygous veins ( right bronchial).
what is the order of lymphatic drainage of the lung?
intrapulmonary vessels and nodes> bronchopulmonary ( hilar) nodes> tracheobronchial ( carinal) nodes> paratracheal nodes> bronchomediastinal lymph trunk> right thoracic trunk/thoracic duct> systemic venous system.
I brought the parachute because the ride sucked
what characterizes pneumonia in the lungs?
the normal air-filled spaces of the alveoli become filled with denser material like fluid or pus..
can be lobar or all of lung
will find lobe consolidation
what characterizes acute pulmonary edema?
collection of fluid in the alveoli, usually due to cardiac failure but can be due to cardiogenic shock, toxins, pneumonia or medications.
has Kerley lines which represent thickening of interlobular ( segmental) septum which become more prominent with edema of the connective tissue of the lung
what characterizes pleural effusion?
excess fluid in the pleural cavity- blunting of costodiaphragmatic recess.
Describe the parasympathetics of the lung
vagus nerve: bronchoconstriction, vasodilation, and increased mucus secretion by glands
Describe the sympathetics of the lung. what nerve and what does it do?
cardiopulmonary nerves: bronchodilation ( beta receptors) and vasoconstriction
what innervates bronchi?
visceral afferents
however no visceral afferents to the lungs and visceral pleura
