Pulmonary- Trauma and Other Pulmonary Conditions Flashcards
Rib Fx, Flail Chest: What is a flail chest
2 or more fractures in 2 or more adjacent ribs
Rib Fx, Flail Chest: Pertinent physical findings
- 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
Pleural Injury: what is a pneumothorax
- 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)
Pleural Injury: pertinent physical findings of pneumothorax
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
Pleural Injury: what is a hemothorax
blood in the pleural space, usually from laceration of the parietal pleura
Pleural Injury: pertinent physical findings of hemothorax
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
Pleural Injury: what is a Lung Contusion
blood and edema w/in the aveoli and interstitial space due to blunt chest trauma w/ or w/out rib fx
Pleural Injury: pertinent physical findings of a lung contusion
- cough w/ hemoptysis (coughing up blood)
- dyspnea
- decreased breath sounds and/or crackles
- cyanosis
- CXR confirmation, ill-defined patchy densities
Pulmonary Edema: What is it
- excessive seepage of fluid from the pulmonary vascular system into the interstitial space
- may eventually cause aveolar edema
Pulmonary Edema: what types are there
cardiogenic and non-cardiogenic
Pulmonary Edema: what is the cardiogenic type
results from increased pressure of the pulmonary capillaries associated w/:
- L ventricular failure
- aortic valvular disease
- mitral valvular disease
Pulmonary Edema: what is the non-cardiogenic type
results from increased permeability of the alveolar capillary membranes due to:
- inhalation of toxic fumes
- hypervolemia
- narcotic overdose
- ARDS
Pulmonary Edema: pertinent physical findings
- 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
Pulmonary Emboli: what is it
- thrombus from peripheral venous circulation becomes embolic and lodges in the pulmonary circulation
- small emboli do not cause infarction
Pulmonary Emboli: Commonly found in history of someone w/ PE
- DVT
- oral contraceptives
- recent abdominal or hip surgery
- polycythemia
- prolonged bed rest
Pulmonary Emboli: pertinent physical findings
- 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
Pulmonary Emboli: added physical findings w/ pulmonary infarction
- chest pain
- hemoptysis
- CXR shows decreased vascular markings, high diaphragm, pulmonary infiltrate and/or pleural effusion
Pleural Effusion: what is it
excessive fluid between the visceral and parietal pleura
Pleural Effusion: causes
- 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
Pleural Effusion: pertinent physical findings
- 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)
Atelectasis: what is it
collapsed or airless alveolar unit
Atelectasis: caused by
- 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
Atelectasis: pertinent physical findings
- decreased breath sounds
- dyspnea
- tachycardia
- increased temp
- CXR w/ platelike streaks.
