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pnuemothorax Flashcards

1
Q

what is ATLS?

A

advanced trauma life support - standard method for initial management of severely injured patients
- treat biggest threat to life first
ABCDE

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2
Q

what is primary survey?

A

rapid evaluation airway, breathing, circulation, disability, exposure and environment

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3
Q

what is vital to assessments within ATLS?

A

imaging - part of primary survey - chest, pelvis, spine, head
FAST - focused assessment with sonography for trauma

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4
Q

describe the airway assessment with ATLS?

A

assess for patency - foreign bodies and vomit should be removed
exclude facial, mandibular, tracheal and laryngeal injuries
if patient is conscious/ talking - skip airway step
any patient with GCS of 8 or less with a head injury should be intubated

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5
Q

what is the breathing step of ATLS?

A

patient airway does not guarantee adequate ventilation
lungs/ diaphragm must be assessed for potential injuries that could compromise ventilation
assess for tension pneumothorax, tension haemothorax

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6
Q

what is circulation/ haemorrhage control within ATLS?

A

haemodynamic state must be established quickly
bleeding is a major preventable death
external bleeding to be dealt with manual pressure asap
ultrasonography within 5Ps

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7
Q

what are the 5Ps to be assessed by sonography?

A

perihepatic, peri splenic, pelvis, pericardial, pleural

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8
Q

how is disability assessed with ATLS?

A

neurological examination - GCS
all patients with head injury require a head CT

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9
Q

how do you assess environment and exposure?

A

patient should be fully exposed - al clothes cut off to allow for full examination
keep patient warm with blankets and ER should be heated
large volume of fluids that patient could require must be warmed

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10
Q

what is BLS?

A

basic life support
30 chest compressions and 2 rescue breaths
compressions - lower half of sternum at a depth of 5cm for 100-120bpm

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11
Q

what characterised a pnumothorax?

A

small airways obstruction mediated by inflammatory cells - may manifest as emphysema

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12
Q

what are signs of penumothorax?

A

cyanosis, sweating, BREATHLESSNESS - can deteoriate to cardioresp distress

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13
Q

what are common clinical signs of pneumothorax?

A

reduced lung expansion, diminished breath sounds at one side oxygen sats <92%

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14
Q

what is the management of pnuemothorax?

A

oxygen if dropped sats or SoB
needle decompression - large cannula in 2nd ICS, mid clavicle line
chest drain

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15
Q

what do you aim for with oxygen sats in a patient without COPD?

A

> 95%

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16
Q

what % oxygen sats do you aim for in a person with COPD?

A

88-92%

17
Q

what is responsible for fight/ flight response?

A

adrenaline and NA - sympathetic NS

18
Q

what are the three components of the polyvagal theory response to danger?

A
  1. immobilisation - freeze response, body shutting down , feeling numb
  2. mobilisation - SNS helps fight or flight response
  3. social engagement - after facing threat need to be comforted by those around to engage parasympathetic NS
19
Q

what is a pneumothorax?

A

collection of air within pleural space

20
Q

what is primary pneumothorax?

A

occurs in a patient without known resp disease

21
Q

what is a secondary pneumothorax?

A

occurs in a patient with a known resp disease

22
Q

what is a tension pnuemothorax?

A

severe type - medical emergency
the air trapped in pleural space pushes on internal organs - displaces mediastinum structures
haemodynamically compromising

23
Q

who is more at risk of pneumothorax?

A

primary - over 65+
males

24
Q

who is most at risk of spontaneous pneumothorax?

A

younger slim tall build males

25
Q

what is the cause of primary pneumothorax?

A

idiopathic - may be due to rupture of subpleural air bleb - bleb is caused by alveolar rupture which lets air into interlobular sternum

26
Q

what causes secondary pnuemothorax?

A

COPD - rupture of air filled space caused by emphysematous destruction of lung tissue
asthma - rupture of air bulla
cystic fibrosis - endobronchial obstruction causing increased pressure in alveoli leading to alveolar rupture
marfan syndrome - abnormal lung connective tissue formation

27
Q

what can cause a tension pneumothorax?

A

penetrating or blunt trauma
mechanical/ non-invasive ventilation
conversion of simple pneumothorax to tension pneumothorax

28
Q

what is the pathophysiology of pneumothorax?

A

alveolar and atmospheric pressure are greater than intrapleural pressure - this allows for movement across gradients
the increase in pressure within the intrapleural space compresses the lung and the air will continue to move until the pressure has equalised/ entry to pleural space has sealed off

29
Q

what is the pathophysiology of a tension pneumothorax?

A

air enters via a one way valve - cant leave
intrapleural space exceeds the atmospheric pressure and leads to collapse of ipsilateral lung (same side) and shift of mediastinum away from pneumothorax

30
Q

what are the risk factors of pneumothorax?

A

spontaneous - young tall slim build males
smoking, COPD, asthma

31
Q

what symptoms may present with a tension pneumothorax?

A

tracheal deviation, severe tachycardia, hypotension

32
Q

what investigations should be performed within a suspected pneumothorax?

A

full resp exam
bedside investigation - pulse oximetry, lung ultrasoundlabs - FBC, clotting screen, arterial blood gases,
CXR, CT

33
Q

why might a lung ultrasound may be useful in a suspected pneumothorax?

A

used in supine trauma cases - lung sliding is caused by visceral pleura moving back and forth on parietal pleura - this is absent in pneumothorax

34
Q

what would arterial blood gases show in a positive pneumothorax diagnosis?

A

resp alkalosis secondary to hyperventilation
may demonstrate type 1 resp failure

35
Q

what would a CXR show of a simple pneumothorax?

A

visible rim between lung margin and chest wall - absence of lung marking measured at hilium

respiratory (10 decks)

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