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Y4 Acute Care > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

What are the types of Pleural Disease? (3 things)

A
  1. Pleural Effusion
  2. Pneumothorax
  3. Pleurisy (Pleuritis)
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2
Q

What is Pleural Effusion?

A

Fluid in the Pleural space

(between layers of Parietal + Visceral pleura)

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3
Q

What happens to the lungs in Pleural Effusion?

A

Lung exansion limited –> Impaired ventilation

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4
Q

What are the 2 types of Pleural Effusion?

What is the purpose of these classifications?

A

Transudative Pleural Effusion (Low prot in fluid)

Exudative Pleural Effusion (High prot in fluid)

Helps determine the cause

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5
Q

What is the difference between Transudative vs Exudative causes of Pleural Effusions?

A
  • Transudative: fluid moves accross into pleural space (trans = moving across)
  • Exudative: prot leaking out of tissues into pleural space bc inflamm (ex = moving out of)
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6
Q

What are the Exudative causes of Pleural Effusion? (4 things)

A

To do with inflamm:

  1. Infection (Pneumonia / TB)
  2. Lung cancer
  3. Pulmonary Embolism
  4. RA
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7
Q

What are the Transudative causes of Pleural Effusion? (5 things)

A

To do with fluid moving across into pleural space:

  1. Congestive HF (increased Venous pressure)
  2. Constrictive Pericarditis (increased Venous pressure)
  3. Cirrhosis (Hypoalbuminaemia)
  4. Hypothroidism
  5. Meig’s syndrome (R sided Pleural Effusion w Ovarian malignancy)
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8
Q

What are the CF of Pleural Effusions? (7 things)

A
  1. SOB (worse @ lying down)
  2. Pleuritic chest pain (worse @ deep inspiration)
  3. Non-prod cough

@ exam

  1. Dullness to percussion over Effusion
  2. Reduced breath sounds
  3. Reduced chest expansion (assymetrical)
  4. Tracheal deviation (away from Effusion) (if massive)
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9
Q

What investigations should you do for sus Pleural Effusion? (4 things)

A
  1. CXR (PA)
  2. US
  3. Pleural aspiration
  4. Pleural biopsy (if fluid analysis inconclusive)
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10
Q

What will a CXR show in Pleural Effusion? (4 things)

A
  1. Blunting of Costophrenic Angle
  2. Fluid in lung fissures
  3. Meniscus (a curving upwards where it meets chest wall + mediastinum) (if massive)
  4. Tracheal + Mediastinal deviation (if massive)
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11
Q

What is the use of a US in sus Pleural Effusion? (2 things)

A
  1. Confirms Pleural Effusion
  2. Shows any Septations in fluid
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12
Q

What does Septations in the fluid of Pleural Effusions seen in a US indicate?

A

Exudate Peural Effusion (caused by infection e.g TB)

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13
Q

What is the use of Pleural aspiration?

A

Analyse fluid for:

  1. Protein count
  2. Cell count
  3. pH
  4. Glucose
  5. LDH (lactate dehydrogenase)
  6. Microbiology testing

To check if Transudate / Exudate

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14
Q

What does a HIGH / LOW protein count in aspirated Pleural fluid suggest?

A
  • HIGH = Exudate
  • LOW = Transudate
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15
Q

What does a HIGH WBC count in aspirated Pleural fluid suggest?

A

Infection = Exudate

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16
Q

What does a LOW Glucose / pH levels in aspirated Pleural fluid suggest?

A

TB / RA / Malignancy = Exudate

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17
Q

What does a HIGH LDH (lactate dehydrogenase) level in aspirated Pleural fluid suggest?

A

LDG = inflamm marker = Exudate

18
Q

What are the management options for Pleural Effusions? (4 things)

A
  1. Conservative (small effusions)
  2. Pleural aspiration
  3. Chest drain
  4. Pleurodesis (chemical / surgical): removes pleural splace –> prevents fluid accum) (for repeated effusions)
19
Q

What is the difference between Pleural Aspiration vs Chest drain of Pleural Effusions?

A
  • Pleural aspiration: done with a needle, temporary relieves pressure, but risk of repeated effusions
  • Chest drain: drains effusion, stops if from recurring
20
Q

What can be used for CHEMICAL Pleurodesis of a Pleural Effusion? (3 things)

A
  1. Talc
  2. Bleomycin
  3. Tetracycline
21
Q

What is a Pneumothorax?

A

Air getting into Pleural Space

22
Q

Who is your classic Pneumothorax patient?

A

Tall, thin, young man playing sports

23
Q

What are the Risk Factors for Pneumothorax? (5 things)

A
  1. Male
  2. Smoking
  3. FHx
  4. Pre-existing lung diseases: COPD / asthma / pneumonia / CF / lung cancer
  5. CT disease: Marfans / RA
24
Q

What are the causes of Pneumothorax? (3 things)

A
  1. Primary: Spontaneous (in tall, thin young men) (bc ruptured bulla)
  2. Secondary: To existing lung disease
  3. Traumatic: (rib # / stab wound / iatrogenic)
25
Q

What are the iatrogenic causes of Pneumothorax? (3 things)

A
  1. Lung biopsy
  2. Central line insertion
  3. Mechanical ventilation
26
Q

What are the Pathophysiological steps of a Tension Pneumothorax? (6 things)

A
  1. One-way valve forms from damaged tissue
  2. Air enters but can’t escape
  3. Pleural space pressure builds up (tension)
  4. Mediastinum shifts away –> compresses other lung –> Hypoxia
  5. Vena cava + Atria compressed –> Reduced Cardiac function
  6. Rapid CardioResp collapse

(can develop from any type of pneumothorax)

27
Q

What are the CF of Pneumothorax? (10 things)

A
  1. Asymptomatic (if small)
  2. Sweating
  3. SOB
  4. Pleuritic Chest pain
  5. Tachypnoea
  6. Tachycardia

@ exam

  1. Hyper-resonance @ percussion
  2. Reduced breath sounds on affected side
  3. Reduced chest expansion
  4. Tracheal deviation (away from affected side) (in Tension Pneumothorax)
28
Q

What are the CF of Pneumothorax in Mechanically ventilated patients? (2 things)

A
  1. Hypoxia
  2. Increase in ventilation pressures
29
Q

What are CF specific to a Tension Pneumothorax? (5 things)

A
  1. Distended neck veins
  2. Displaced apex beat
  3. Reduced BP
  4. Reduced Oxygen sat
  5. Epigastric pain
30
Q

What investigations should you do for sus Pneumothorax? (2 things)

A
  1. Erect CXR
  2. CT (for pneumothorax too small to see on CXR)
31
Q

What investigations should you do for a TENSION Pneumothorax?

A

None nigga

It’s a clinical diagnosis, as soon as you sus, start management

MEDICAL EMERGENCY

32
Q

What will you see on a Erect CXR of Pneumothorax? (2 things)

A
  1. Edge of lung reduced
  2. Area of no lung markings (where pneumothorax is)
33
Q

What will you see on a Erect CXR of a TENSION Pneumothorax? (4 things)

A
  1. Tracheal deviation (away from pneumothorax)
  2. Collapsed lung
  3. Edge of lung reduced
  4. Area of no lung markings (where pneumothorax is)
34
Q

What is the use of a CT scan in Pneumothorax? (2 things)

A
  1. Detect small pneumothorax (too small to see on CXR)
  2. Accurate measurement of Pneumothorax size
35
Q

What are the British Thoracic Society guidelines for Pneumothorax management? (4 things)

A
  1. No SOB, pneumothorax under 2cm –> No management req
  2. SOB +/- pneumothorax over 2cm –> Aspiration
  3. Aspiration fails 2x –> Chest drain
  4. Pneumothorax bc Trauma / Mechanical ventilation –> Chest Drain
  5. Unstable pt / Bilateral / 2ndary Pneumothorax –> Chest Drain
36
Q

What is the management for a TENSION Pneumothorax? (2 things)

A
  1. Large bore cannula (to relieve pressure ASAP)
  2. Chest drain (definitive management)

Learn this phrase: Insert a large bore cannula into the 2nd intercostal space in the midclavicular line

Once pressure relieved w Cannula –> Chest drain = definitive management

37
Q

Where is a Chest Drain inserted for Pneumothorax?

What is this formed by? (3 things)

A

Triangle of Safety

Formed by:

  1. 5th intercostal space (aka inf nipple line)
  2. Mid axillary line
  3. Ant axillary line
38
Q

What do you need to keep in mind when inserting a Chest drain? (2 things)

A
  1. Insert ABOVE rib, to avoid neurovasc bundle under rib
  2. Do a CXR after to check positioning
39
Q

What are the complications of a Pneumothorax? (6 things)

A
  1. Resp faliure
  2. Cardiac arrest
  3. Pneumomediastinum (air in mediastinum)
  4. Pneumoperitoneum (air in Peritoneal cavity)
  5. Re-expansion Pulmonary Edema (higher risk if collapsed for few days)
  6. Recurrence
40
Q

What are the complications of the management procedures for Pneumothorax? (3 things)

A
  1. Infection / bleeding
  2. Fistula formation / air leaks
  3. Intercostal nerve damage (if u put chest drain under rib like an idiot)

Y4 Acute Care (31 decks)

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