Pulmonary- Trauma and Other Pulmonary Conditions

Question 1

Rib Fx, Flail Chest: What is a flail chest

Answer 1

2 or more fractures in 2 or more adjacent ribs

Question 2

Rib Fx, Flail Chest: Pertinent physical findings

Answer 2

• shallow breathing
• splinting due to pain. pain increases w/ coughing and deep breath
• crepitation can be felt during the ventilatory cycle. -
• paradoxical movement: during inspiration the flail is pulled inward and outward w/ expiration (opposite of what normally happens w/ ribs)
• confirmation by CXR

Question 3

Pleural Injury: what is a pneumothorax

Answer 3

• air in the pleural space, usually through a lacerated visceral pleura from a rib fracture or ruptured bullae (which means a rounded prominence or a bubblelike cavity filled with air or fluid)

Question 4

Pleural Injury: pertinent physical findings of pneumothorax

Answer 4

basically the same as hemothorax

• chest pain
• dyspnea
• tracheal and mediastinal shift away from injured side (IMPORTANT!)
• absent or decreased breath sounds
• increased tympany w/ mediate percussion (different from hemothorax)
• cyanosis
• respiratory distress
• confirmation on CXR

Question 5

Pleural Injury: what is a hemothorax

Answer 5

blood in the pleural space, usually from laceration of the parietal pleura

Question 6

Pleural Injury: pertinent physical findings of hemothorax

Answer 6

basically same as a pneumothorax

• chest pain
• dyspnea
• tracheal and mediastinal shift away from injured side (IMPORTANT!)
• absent or decreased breath sounds
• cyanosis
• respiratory distress
• confirmation on CXR
• possible signs of blood loss (different from pneumothorax

Question 7

Pleural Injury: what is a Lung Contusion

Answer 7

blood and edema w/in the aveoli and interstitial space due to blunt chest trauma w/ or w/out rib fx

Question 8

Pleural Injury: pertinent physical findings of a lung contusion

Answer 8

• cough w/ hemoptysis (coughing up blood)
• dyspnea
• decreased breath sounds and/or crackles
• cyanosis
• CXR confirmation, ill-defined patchy densities

Question 9

Pulmonary Edema: What is it

Answer 9

• excessive seepage of fluid from the pulmonary vascular system into the interstitial space
• may eventually cause aveolar edema

Question 10

Pulmonary Edema: what types are there

Answer 10

cardiogenic and non-cardiogenic

Question 11

Pulmonary Edema: what is the cardiogenic type

Answer 11

results from increased pressure of the pulmonary capillaries associated w/:

• L ventricular failure
• aortic valvular disease
• mitral valvular disease

Question 12

Pulmonary Edema: what is the non-cardiogenic type

Answer 12

results from increased permeability of the alveolar capillary membranes due to:

• inhalation of toxic fumes
• hypervolemia
• narcotic overdose
• ARDS

Question 13

Pulmonary Edema: pertinent physical findings

Answer 13

• crackles
• tachypnea
• dyspnea
• hypoxemia
• peripheral edema if cardiogenic
• cough w/ pink frothy secretions
• CXR shows increased vascular markings, hazy opacities in gravity dependent areas of lung in butterfly patterns, atelectasis is possible if sufficant lining is removed by aveolar edema

Question 14

Pulmonary Emboli: what is it

Answer 14

• thrombus from peripheral venous circulation becomes embolic and lodges in the pulmonary circulation
• small emboli do not cause infarction

Question 15

Pulmonary Emboli: Commonly found in history of someone w/ PE

Answer 15

• DVT
• oral contraceptives
• recent abdominal or hip surgery
• polycythemia
• prolonged bed rest

Question 16

Pulmonary Emboli: pertinent physical findings

Answer 16

• sudden onset or dyspnea
• tachycardia
• hypoxemia
• cyanosis
• auscultatory findings may be normal or show crackles and decreased breath sounds
• ventilation- perfusion scan showing perfusion defects w/ concomitant normal ventilation

Question 17

Pulmonary Emboli: added physical findings w/ pulmonary infarction

Answer 17

• chest pain
• hemoptysis
• CXR shows decreased vascular markings, high diaphragm, pulmonary infiltrate and/or pleural effusion

Question 18

Pleural Effusion: what is it

Answer 18

excessive fluid between the visceral and parietal pleura

Question 19

Pleural Effusion: causes

Answer 19

• increase in pleural permeability to proteins from inflammatory diseases such as pneumonia, RA, and SLE
• neoplastic disease
• increased hydrostatic pressure w/ pleural space such as with CHF
• decrease in osmotic pressure such as w/ hypoproteinemia
• peritoneal fluid w/in pleural space such as w/ ascites or cirrhosis
• interference of pleural reabsorption from a tumor invading pleural lymphatics

Question 20

Pleural Effusion: pertinent physical findings

Answer 20

• decreased breath sounds over effusion, bronchial breath sounds around the perimeter. pleural friction rub may be possible w/ inflammatory process
• mediastinal shift AWAY from large effusion
• breathlessness w/ large effusions
• CXR shows fluid in the pleural space in gravity dependent areas of the thorax if >300 mL
• pain and fever only if the pleural fluid is infected (empyema)

Question 21

Atelectasis: what is it

Answer 21

collapsed or airless alveolar unit

Question 22

Atelectasis: caused by

Answer 22

• hypoventilation secondary to pain during ventilatory cycle. Think pleuritis, postop pain, rib fx
• internal bronchial obstruction, Think aspiration or mucus plugging
• external bronchial compression. Think tumor or enlarged lymph nodes
• low tidal volumes. Think narcotic overdose, inappropriately low vent settings
• neurologic insult

Question 23

Atelectasis: pertinent physical findings

Answer 23

• decreased breath sounds
• dyspnea
• tachycardia
• increased temp
• CXR w/ platelike streaks.