Moore's Blue Boxes for Thoracic Region Flashcards
Chest Pain
Most important Sx of cardiac disease - ppl who have had MI describe crushing sub-sternal pain that does not disappear with rest
May also appear with intestinal, gallbladder, and MSK disorders.
Rib Fractures
1st rib - rarely fractured. If fractured, structures superior to it (brachial plexus, subclavian a.) may be injured
Middle ribs most commonly fractured from blows/crushing injury
Weakest part = just anterior to angle
Simple vs. Complicated (complicated - trauma to pleura, blood vessels, heart, etc.)
Flail Chest
Multiple rib fractures leads to a sizable segment of the thoracic wall moving freely
Thoracotomy vs. Thoroscopy
Thoracotomy = Surgically opening thoracic wall to enter pleural cavity
Thoroscopy = insertion of thoroscope into pleural cavity through small incisions for visualizing space inside pleural cavity
Supernumerary Ribs
Extra ribs either in cervical or lumbar region usually with no significant symptoms
Dislocation vs. Seperation
Dislocation is at the SC joint
Seperation is at the costochondral joint
Thoracentisis
Insertion of a needle through the intercostal space between ribs to obtain fluid sample or drain blood/fluid from pleural cavity. Needle must be inserted below neuromuscular bundle but above collateral branches.
Insertion of Chest Tube
Tube is inserted into the 5th/6th intercostal space to remove large amounts of air, fluid, blood, pus, etc.
Lung Cancer
Can derive from actual lung tissue or bronchi. Can involve phrenic, vagus, and recurrent laryngeal n.
Tx: Pneumonectomy, lobectomy, segmentectomy - lung resection
Pleuritis
Inflammation of pleura producing roughness on lungs making breathing difficult
Pulmonary Collapse
When enough air enters pleural cavity to break surface tension between 2 layers of pleura - elasticity causes collapse
Pneumothorax,
Entry of air into pleural cavity from penetrating wound to thoracic wall or rupture of pulmonary lesion into pleural cavity - results in lung collapse
Hydrothorax
Accumulation of excess fluid into pleural cavity - result is fluid escape into pleural cavity (pleural effusion)
Hemothorax
Accumulation of blood in pleural cavity due to chest wound. Blood accumulating from intercostal vessel rather than lung laceration
Bronchial Asthma
Widespread narrowing of airways produced by contraction of smooth muscle, edema of mucosa in lumen of bronchi and bronchioles
Bronchoscopy
Insertion of a bronchoscope into trachea to visualize main bronchi
Myocardial Infarction
Lack of blood flow to specific area of myocardium, usually result of blockade in a coronary artery.
Coronary Atherosclerosis, buildup of lipids on internal walls, decreases size of lumen of vessel, increasing likelihood of embolus or block of vessel entirely
Angina Pectoris
Pain that originates in heart and produces strangling pain of chest (literal meaning).
Result of narrow or obstructed coronary arteries that produces ischemia of myocardium
Atrial Septal Defect
Involves incomplete closure of Foramen Ovalis
15-20% adults have small latency of foramen ovals - clinically insignificant
Larger openings in inter arterial septum can be clinically significant and they allow for mixture of oxygen rich and depleted blood
Cardiac Catheterization
Insertion of catheter into femoral vein which is then passed up to IVC allowing radiographic visualization of right atrium, right ventricle, pulmonary trunk, and pulmonary arteries
Ventricular Septal Defects
Due to embryologically divergent tissues that make up inter ventricular septum, it is particularly susceptible to defects. Clinically significant as they allow for mixture of oxygen rich and depleted blood
Artificial Cardiac Pacemaker
Produces regular electrical impulse that is carried to the ventricles via electrodes which are inserted through a large vein to the SVC, into right atrium past the tricuspid valve into the endocardium of the trabecular carnae of the right ventricle
Atrial Fibrillation
Irregular twitching of the atrial cardiac muscle fibers to which the ventricles respond at irregular intervals. Circulation usually remains satisfactory.
Ventricular Fibrillation
Rapid irregular twitching of ventricles rendering the heart unable to pump blood.
Electric shock administered by electrodes can cease all cardiac movement (defibrillation)
Cardiac Referred Pain
Ischemia stimulates visceral pain sensory fibers in the heart of ANS. These visceral sensory fibers share a spinal ganglion with the somatic sensory fibers of areas such as UE and superior lateral chest wall
Surgical significance of Transverse pericardial sinus
Space allows cardiac surgeons to access area posterior to aorta and pulmonary trunk to clamp or insert the tubes of a bypass machine into these large vessels
Pericarditis
Inflammation of the pericardium, which can make the pericardium rough and produce friction. If untreated, pericardium can calcify
Friction –> pericardial friction rub can be observed with stethoscope
Pericardial Effusion
Inflammation of pericardium can result in accumulation of fluid or pus in the pericardial sac which can compress heart
Heart compression = cardiac tamponade
Pericardiocentesis
Drainage of blood, fluid, or pus form pericardial sac.
Done to relieve cardiac tamponade
Coronary Artery Bypass Graft
Obstruction of coronary arteries may necessitate replacement of segment of coronary artery
Great saphenous vein is often used based on its comparable diameter of the coronary arteries, its easy dissection
Radial artery is also used
Coronary Angioplasty
Insertion of small balloon catheter into lumen of coronary artery. Balloon inflated to flatten the obstruction plaque against the wall and increase size of lumen improving blood flow
