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Pleural diseases Flashcards

1
Q

What is the definition of a pneumothorax?

A

A collection of gas in the pleural space

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2
Q

What is the difference between a normal pneumothorax and a tension pneumothorax

A

The presence of a “one way valve” in the tissues that allows air to enter the chest cavity when there is negative pressure generated during inspiration but does not allow gas to escape during expiration resulting in increased amounts of gas in the pleural space with each breath

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3
Q

What is “special” about a tension pneumothorax?

A

Will put pressure on the heart and reduce cardiac output

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4
Q

A visual sign of a pneumothorax is what?

A

Unilateral chest expansion

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5
Q

What is the acronym used in regards to a suspected pneumothorax?

A

FAST
Focused Assessment with Sonography for Trauma
Standard tool for trauma assessment

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6
Q

How is a pneumothorax emergently treated?

A

Needle decompression

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6
Q

Where is the needle inserted during a needle decompression?

A

Second intercostal space
Mid clavicular line
Over top of the rib

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7
Q

Why does the needle need to be inserted over top of the rib?

A

To avoid nerves arteries and veins on the undersides of the ribs

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8
Q

What should you do if the chest wall is too thick for a normal needle decompression?

A

Move the insertion site to the 4th or 5th intercostal space at the anterior axillary line

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9
Q

What is a hemothorax?

A

A collection of blood in the pleural space

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9
Q

What typically follows a needle decompression?

A

A chest tube

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10
Q

How might a patient with a hemothorax present when you perform a chest assessment?

A

Dull to percussion
Tachycardia
Hypotension

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11
Q

What can produce a hemothorax?

A

Aortic rupture
Myocardial rupture
Injuries to hilar structures
Injuries to intercostal blood vessels
Injuries to mammary blood vessels

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12
Q

What are the consequences of a hemothorax?

A

Crush lungs and heart
Restrictive lung conditions
Compromise of oxygen delivery
Hypovolemic shock

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13
Q

What is the minimum amount of blood required for a hemothorax to be visible on a CXR?

A

300 ml

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14
Q

Describe acute management of a “mild” hemothorax

A

28-32 french chest tube
Placed in 4th or 5th intercostal space in mid axillary or anterior axillary line

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15
Q

What position is the best for seeing a hemothorax on a CXR?

A

Upright
Blood pools in the bases

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16
Q

Describe management of a “severe” hemothorax

A

Emergent
Massive transfusion protocol
Surgical or ED thoracotomy to drain blood and treat source of bleeding

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17
Q

What qualifies as a “mild” hemothorax?

A

HTX > 300-500 ml

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18
Q

What qualifies as a “severe” hemothorax?

A

HTX > 1500 ml
Continuous bleeding

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19
Q

What does massive transfusion mean? Why is it necessary?

A

Blood loss is replaced with blood product
Normal saline cannot carry oxygen and lacks clotting factors

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20
Q

What are the characteristic patient presentations associated with a pneumothorax?

A

Sudden onset
Dyspnea
Sharp pleuritic pain

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21
Q

What are the 4 types of pneumothorax?

A

Tension pneumo
Primary spontaneous pneumo
Secondary spontaneous pneumo
Iatrogenic pneumo

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21
Q

Describe a primary spontaneous pneumothorax

A

Pneumothorax lacking external cause
Sometimes tied to drug use or increased transpulmonary pressure

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22
Describe a spontaneous pneumothorax
Just happens More common in tall skinny males
23
Describe a secondary spontaneous pneumothorax
pneumothorax with causal link to other pathology
24
What causal pathologies are linked to secondary spontaneous pneumothoraxes?
CF, COPD, Asthma TB, necrotizing PNA Marfan syndrome Lung cancer or metastatic disease
25
Describe an Iatrogenic pneumothorax
Pneumothorax caused by medical intervention
26
What are some causes of iatrogenic pneumothorax
Lung biopsy Seed placement Central venous catheterization Mechanical ventilation Pacemaker insertion Tracheostomy
27
What does a pneumothorax look like on an xray?
Lack of vasculature in lung field Occasionally a border between lung and expanding pleural space is visible
28
What is deep sulcus sign?
CXR of a supine patient with a pneumothorax where air collects lower in the abdomen forming a deep sulcus sign instead of a sharp costaphrenic angle
29
How are emergent pneumothoraces treated?
Needle decompression Finger thoracostomy Chest tube
30
How are stable pneumothoraces treated?
Continual assessment of size and impact of pneumothorax Supplemental oxygen if necessary Time
31
How can you increase the speed at which the gas in the pleural space is reabsorbed in a stable pneumothorax?
Give supplemental oxygen increasing the partial pressure of oxygen in the blood and decreasing the partial pressure of nitrogen so that the nitrogen in the pleural space is more readily absorbed by the blood
32
What is a treatment option for individuals with recurrent pneumothorax?
Pleurodesis
33
What is a pleurodesis?
Visceral pleura is exposed to irritants to cause inflammation and fibrosis of the tissue resulting in the visceral and parietal pleura being fused together
34
Describe a pleural effusion
Excessive fluid in the pleural space
35
What is one of the most important things to consider when evaluating a pleural effusion
What is the liquid in the pleural space and what is causing it?
36
T/F: 10% of patient will have a pleural effusion after a CABG in the early post op period
False. 90% of patients will have a pleural effusion after a CABG in the early post op period
37
T/F: 90% of people hospitalized for bacterial PNA will develop a pleural effusion
False. 20-40% of people hospitalized for bacterial PNA will develop a pleural effusion
38
T/F: there is no link between lung cancer and pleural effusions
False. 15% of patient with lung cancer will develop a malignant pleural effusion
39
Pleural effusions can be caused by failures in which organs
Lungs Heart Liver Kidneys
40
Describe how left sided heart failure can lead to a pleural effusion
The left side of the heart fails to move fluid forward Fluid collects in the pulmonary vasculature Hydrostatic pressure increases Fluid pushes out into pleural space
40
In left sided heart failure, what is the source of the fluid? (where does it leak out from?
Leaks from the vasculature along visceral pleura into pleural space
41
Describe how right sided heart failure can lead to a pleural effusion
The right side of the heart fails to move fluid forward Fluid collects in systemic vasculature Hydrostatic pressure in systemic vasculature increases Fluid is pushed out into pleural space
42
How can the liver cause a pleural effusion?
Failure to produce albumin (main protein used to maintain oncontic pressure)
42
In right sided heart failure, what is the source of the fluid? (where does it leak out from?)
The fluid leaks into the pleural space from the systemic vasculature along the parietal pleura
43
Describe the pathophysiology of how liver failure can cause a pleural effusion
Liver doesnt produce albumin Fluid leaks out of blood into peritoneal space Ascites forms Hydrostatic pressure of ascites is so great that it pushes fluid through diaphragm into pleural space Protein poor fluid gathers in pleural space
44
What condition in the lungs can cause a pleural effusion?
Pulmonary embolism
45
How can the kidneys cause a pleural effusion?
Failure to retain protein Passed in urine, lowers oncotic pressure
46
How can a pulmonary embolism cause a pleural effusion
PE blocks circulation Causes increased hydrostatic pressure Increased pressure pushes fluid out into lung and into pleural space
47
What is a parapneumonic effusion?
Pleural effusion caused by bacterial PNA Increased fluid collection resulting from the PNA results in fluid leaking into the pleural space
48
What differentiates a complicated parapneumonic PNA from a simple parapneumonic PNA?
Complicated parapneumonic PNA results when bacteria cross into the pleural fluid resulting in inflammation and infection
49
What is a collection of pus in pleural space called?
Empyema
50
How can problems with the gastrointestinal tract cause a pleural effusion?
Issues with lymphatic drainage can misdirect fluids into the pleural space
51
What cancers are most like to cause pleural effusions?
Lung, breast ovaries
52
How can cancer cause pleural effusions?
Metastasis near lymph nodes can disrupt lymphatic drainage
53
What is a malignant pleural effusion/
When cancer cells make in into the pleural space
54
A patient with a pleural effusion may complain of
Dyspnea Pleuritic chest pain Cough Chest pressure or feeling of fullness
55
What findings on a chest assessment would be indicative of a pleural effusion?
Diminished breath sounds in affected area Dull percussion notes in affected area Decreased vocal fremitus Egophony Pleural friction run Asymmetrical chest excursion
56
What imaging techniques can be used to detect a pleural effusion
Ultrasound Chest radiograph CT scan
57
What is the term for a pleural effusion that is trapped in one place and doesnt follow gravity?
A loculated pleural effusion
58
What can be assumed if a patient has transudative fluid in the pleural space?
That the pleural surfaces are healthy
59
The pleural spaces are diseased
60
Describe transudate
Thin watery fluid Protein poor
61
Describe exudate
Fluid with high viscosity than transudate Protein rich Great deal of cell debris
62
What does straw colored fluid from the pleural cavity indicate?
Transudate Not from infection
63
What does red fluid from the pleural cavity indicate?
Malignancy or trauma
64
What does milky white fluid from the pleural cavity indicate?
Chylothorax or cholesterol effusion
65
What does brown fluid from the pleural cavity indicate?
Old blood
66
What does black fluid from the pleural cavity indicate?
Malignancy
67
What are the tests run on fluid gathered from a thoracentesis?
Cell count and differential pH Protein LDH Glucose
68
What are the two “rules” used to differentiate between transudative and exudative pleural effusions
Lights criteria rule Three test rule
69
What are options for treating a pleural effusion
Time Thoracentesis Chest tube Pleurodesis Indwelling pleural catheter
70
Describe a thoracentesis
Needle inserted into pleura space to drain fluid No more than 1.5 liters removed at a time to prevent negative consequences
71
How does a pleurodesis prevent pleural effusions?
Collapses the space between the layers of pleura preventing further fluid collection
72
Describe an indwelling pleural catheter
Negative pressure bottle pulls fluid out of pleural effusion via indwelling catheter Offered to patients who do not want pleurodesis

Disease 2 (16 decks)

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