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Disease 2 > Pleural diseases > Flashcards

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
Q

Describe a spontaneous pneumothorax

A

Just happens
More common in tall skinny males

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23
Q

Describe a secondary spontaneous pneumothorax

A

pneumothorax with causal link to other pathology

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24
Q

What causal pathologies are linked to secondary spontaneous pneumothoraxes?

A

CF, COPD, Asthma
TB, necrotizing PNA
Marfan syndrome
Lung cancer or metastatic disease

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25
Q

Describe an Iatrogenic pneumothorax

A

Pneumothorax caused by medical intervention

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26
Q

What are some causes of iatrogenic pneumothorax

A

Lung biopsy
Seed placement
Central venous catheterization
Mechanical ventilation
Pacemaker insertion
Tracheostomy

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27
Q

What does a pneumothorax look like on an xray?

A

Lack of vasculature in lung field
Occasionally a border between lung and expanding pleural space is visible

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28
Q

What is deep sulcus sign?

A

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
Q

How are emergent pneumothoraces treated?

A

Needle decompression
Finger thoracostomy
Chest tube

30
Q

How are stable pneumothoraces treated?

A

Continual assessment of size and impact of pneumothorax
Supplemental oxygen if necessary
Time

31
Q

How can you increase the speed at which the gas in the pleural space is reabsorbed in a stable pneumothorax?

A

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
Q

What is a treatment option for individuals with recurrent pneumothorax?

A

Pleurodesis

33
Q

What is a pleurodesis?

A

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
Q

Describe a pleural effusion

A

Excessive fluid in the pleural space

35
Q

What is one of the most important things to consider when evaluating a pleural effusion

A

What is the liquid in the pleural space and what is causing it?

36
Q

T/F: 10% of patient will have a pleural effusion after a CABG in the early post op period

A

False. 90% of patients will have a pleural effusion after a CABG in the early post op period

37
Q

T/F: 90% of people hospitalized for bacterial PNA will develop a pleural effusion

A

False. 20-40% of people hospitalized for bacterial PNA will develop a pleural effusion

38
Q

T/F: there is no link between lung cancer and pleural effusions

A

False. 15% of patient with lung cancer will develop a malignant pleural effusion

39
Q

Pleural effusions can be caused by failures in which organs

A

Lungs
Heart
Liver
Kidneys

40
Q

Describe how left sided heart failure can lead to a pleural effusion

A

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
Q

In left sided heart failure, what is the source of the fluid? (where does it leak out from?

A

Leaks from the vasculature along visceral pleura into pleural space

41
Q

Describe how right sided heart failure can lead to a pleural effusion

A

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
Q

How can the liver cause a pleural effusion?

A

Failure to produce albumin (main protein used to maintain oncontic pressure)

42
Q

In right sided heart failure, what is the source of the fluid? (where does it leak out from?)

A

The fluid leaks into the pleural space from the systemic vasculature along the parietal pleura

43
Q

Describe the pathophysiology of how liver failure can cause a pleural effusion

A

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
Q

What condition in the lungs can cause a pleural effusion?

A

Pulmonary embolism

45
Q

How can the kidneys cause a pleural effusion?

A

Failure to retain protein
Passed in urine, lowers oncotic pressure

46
Q

How can a pulmonary embolism cause a pleural effusion

A

PE blocks circulation
Causes increased hydrostatic pressure
Increased pressure pushes fluid out into lung and into pleural space

47
Q

What is a parapneumonic effusion?

A

Pleural effusion caused by bacterial PNA
Increased fluid collection resulting from the PNA results in fluid leaking into the pleural space

48
Q

What differentiates a complicated parapneumonic PNA from a simple parapneumonic PNA?

A

Complicated parapneumonic PNA results when bacteria cross into the pleural fluid resulting in inflammation and infection

49
Q

What is a collection of pus in pleural space called?

A

Empyema

50
Q

How can problems with the gastrointestinal tract cause a pleural effusion?

A

Issues with lymphatic drainage can misdirect fluids into the pleural space

51
Q

What cancers are most like to cause pleural effusions?

A

Lung, breast ovaries

52
Q

How can cancer cause pleural effusions?

A

Metastasis near lymph nodes can disrupt lymphatic drainage

53
Q

What is a malignant pleural effusion/

A

When cancer cells make in into the pleural space

54
Q

A patient with a pleural effusion may complain of

A

Dyspnea
Pleuritic chest pain
Cough
Chest pressure or feeling of fullness

55
Q

What findings on a chest assessment would be indicative of a pleural effusion?

A

Diminished breath sounds in affected area
Dull percussion notes in affected area
Decreased vocal fremitus
Egophony
Pleural friction run
Asymmetrical chest excursion

56
Q

What imaging techniques can be used to detect a pleural effusion

A

Ultrasound
Chest radiograph
CT scan

57
Q

What is the term for a pleural effusion that is trapped in one place and doesnt follow gravity?

A

A loculated pleural effusion

58
Q

What can be assumed if a patient has transudative fluid in the pleural space?

A

That the pleural surfaces are healthy

59
Q
A

The pleural spaces are diseased

60
Q

Describe transudate

A

Thin watery fluid
Protein poor

61
Q

Describe exudate

A

Fluid with high viscosity than transudate
Protein rich
Great deal of cell debris

62
Q

What does straw colored fluid from the pleural cavity indicate?

A

Transudate
Not from infection

63
Q

What does red fluid from the pleural cavity indicate?

A

Malignancy or trauma

64
Q

What does milky white fluid from the pleural cavity indicate?

A

Chylothorax or cholesterol effusion

65
Q

What does brown fluid from the pleural cavity indicate?

A

Old blood

66
Q

What does black fluid from the pleural cavity indicate?

A

Malignancy

67
Q

What are the tests run on fluid gathered from a thoracentesis?

A

Cell count and differential
pH
Protein
LDH
Glucose

68
Q

What are the two “rules” used to differentiate between transudative and exudative pleural effusions

A

Lights criteria rule
Three test rule

69
Q

What are options for treating a pleural effusion

A

Time
Thoracentesis
Chest tube
Pleurodesis
Indwelling pleural catheter

70
Q

Describe a thoracentesis

A

Needle inserted into pleura space to drain fluid
No more than 1.5 liters removed at a time to prevent negative consequences

71
Q

How does a pleurodesis prevent pleural effusions?

A

Collapses the space between the layers of pleura preventing further fluid collection

72
Q

Describe an indwelling pleural catheter

A

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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