Resp - Pneumothorax, Pleural Effusion, Pneumonia, Pulmonary HTN, Sarcoidosis, PE Flashcards
Pneumothorax - what is it?
Pneumothorax - is when air gets in the pleural space separating the lung from the chest wall
Pneumothorax - what are 4 causes?
- Spontaneous
- Trauma
- Iatrogenic e.g. lung biopsy
- Pathology - infection, COPD
Pneumothorax - what is the investigation of choice?
Erect chest x-ray
Pneumothorax - what would you see on a chest x-ray?
Area between lung tissue and chest wall with no lung markings
Line demarcating lung edge, where lung markings end and pneumothorax begins
Pneumothorax - what is the stepwise management?
- No SoB, <2cm rim of air on CXray - no treatment, resolve by itself, reassess in 2-4 weeks
- If SoB, >2cm rim of air on CXray - aspiration and reassess
- If aspiration fails twice - CHEST DRAIN
- Unstable patients or bilateral or secondary pneumothoraces - CHEST DRAIN
Pneumothorax - what is a tension pneumothorax?
Tension pneumothorax caused by trauma to chest wall creating one way valve:
Air can get into pleural space during inspiration
Air can’t escape during expiration
So more air drawn into pleural space with each breath, can’t escape, pressure builds inside mediastinum, pushes mediastinum across (away from TP), kinks big vessels, can cause cardiorespiratory arrest
Pneumothorax - signs of tension pneumothorax on examination and obs?
Reduced air entry to affected side
Tachycardic
Hypotension
Pneumothorax - what would a tension pneumothorax show on XRAY?
Tracheal deviation away from pneumothorax side
Pneumothorax - management of tension pneumothorax?
Insert a large bore cannula into the second intercostal space in the midclavicular line
Once pressure is relieved with cannula, do chest drain fro definitive management
Pleural effusion - what is it?
Collection of fluid in pleural cavity
Pleural effusion - what are the two types of fluid it can be?
Exudative - high protein count >3g/dL
Transudative <3g/dL
Pleural effusion - what are exudative causes?
Exudative causes related to inflammation
Inflammation results with protein leaking out of tissues into pleural space
‘EX’udative - meaning moving out
Lung cancer
Pneumonia
Rheumatoid A
TB
Pleural effusion - what are transudative causes?
Transudative causes relate to fluid moving into the pleural space
‘TRANS’udative - meaning moving across
Congestive Cardiac Failure
Hypothyroidism
Hypoalbuminaemia - liver disease, less protein in blood so reduced oncotic pressure, so fluid moves out of blood vessels as oncotic pressure from albumin (protein), isn’t there to keep fluid in
Pleural effusion - what are the symptoms?
- SoB
- Pleuritic pain
- Non-productive cough
- Extra-pulmonary symptoms depending on underlying cause e.g. weight loss in malignancy
Pleural effusion - what are the signs?
Stony dull percussion over effusion
Reduced breath sounds
Tracheal deviation away from effusion if massive (>1000ml)
Reduced chest expansion
Pleural effusion - what imaging do you do and what do you see?
Chest X-Ray
Blunting of costophrenic angles
Meniscus if big effusion
Fluid in lung fissures
Tracheal deviation away from effusion
Pleural effusion - what other investigation can you do?
Pleural paracentesis and analysis
Analyse for protein count, pH, glucose, lactate dehydrogenase, microbiology testing
Pleural effusion - management
Should be directed towards underlying cause
- Small effusion - conservative management may be appropriate, as may resolve by fixing underlying cause
- Large effusion - pleural aspiration, effusion may recur, may need to repeat aspiration
- Chest drain - used to drain effusion and prevent it recurring
Pneumonia - what is it?
Infection of the lung tissue
Causes inflammation of lung tissue and sputum filling the airways and alveoli
Pneumonia - what are the three classifications of pneumonia?
COMMUNITY ACQUIRED PNEUMONIA - pneumonia developed outside of hospital
HOSPITAL ACQUIRED PNEUMONIA - develops >48 hours after hospital admission
ASPIRATION PNEUMONIA - develops as a result after inhaling foreign material
Pneumonia - what is the presentation?
SoB Productive cough Fever Haemoptysis Pleuritic chest pain Confusion
Pneumonia - what are the signs (obs)?
Tachypnoea Tachycardia Hypoxia Hypotension Fever Confusion
These obs can indicate sepsis secondary to pneumonia
Pneumonia - what are the signs on chest examination?
Bronchial breath sounds - heard on inspiration and expiration
Focal coarse crackles - this is the sound of air passing through the sputum
Dullness to percussion
Pneumonia - CRB65 and CURB65
CRB65 out of hospital
CURB65 in hospital
In CRB65, if score is anything other than 0, consider referral to hospital
Score predicts mortality, used to help guide whether to admit patient to hospital
Pneumonia - what are the parameters of CURB65?
C - confusion U - urea >7 R - resp rate >30 B - <90 systolic <60 diastolic 65 - age >65
Pneumonia - CURB65 scores
0/1 - consider home treatment
>2 consider hospital admission
>3 consider ICU assessment