Respiratory Core Conditions Flashcards
What are the different types of pneumothoraces?
Tension: Life threatening
Open: Defect in chest wall
Primary/Spont: No underlying pathology.
Secondary: Trauma/underlying lung disease (COPD)
Who most commonly has a primary spontaneous pneumothorax?
Tall, thin young men due to ruptured pleural bleb
What are the clinical features of a tension pneumothorax
Pleuritic chest pain Breathlessness Reduced breath sounds Hyper-resonant percussion Tracheal deviation
What are the features of a tension pneumothorax on a CXR?
Tracheal deviation AWAY from the pneumothorax
Obvious lung collapse
How is a tension pneumothorax life-threatening?
Continuing increase in volume
Due to formation of one way valve allowing air into pleural space on inspiration but not out on expiration
Causes rapid increase in intra-thoracic pressure
Reduces venous return & dec CO leading to cardiac arrest
How is a pneumothorax investigated?
Tension should be diagnosed on clinical findings NOT CXR!!
CXR
CT if uncertainty
How is a pneumothorax treated?
Small: <2cm resolves with conservative treatment, no strenuous exercise, reassess 2weekly until air reabsorbed
Primary: SOB & >2cm on CXR, attempt aspiration, can be repeated
Secondary: SOB & >2cm on CXR, chest pain
How is a tension pneumothorax treated?
Large bore needle decompression 2nd intercostal space midclavicular
Chest drain: 5th intercostal space midaxillary
If at 48hours PT still remains or recurrence: Pleurectomy
What are the RFs of a pneumothorax?
Smoking Marfan's Homocystinuria FHx Lung disease: COPD, acute s. asthma, TB, CF
What are the different types of emboli?
Blood
Fat
Air
Amniotic fluid
What is the pathophysiology of a PE?
Usually complication of VTE from another source (Calf, pelvis) that becomes dislodged and flows via the bloodstream through the R side of the heart and lodges in the pulmonary circulation
What are the signs & symptoms of a PE?
Pyrexia Cyanosis Tachypnoea & SOB RR >16 Tachycardia HypoT Raised JVP Pleural rub Pleural effusion Previous DVT signs Pleuritic chest pain Cough (+/- haemoptysis)
How is a PE investigated?
PERC score Well's score D-Dimer: -ve can rule out but +ve not necessarily due to PE CXR: Exclude other causes ECG: Mostly normal, can be sinus tachy, sometimes T-wave inversion (lead 3) CTPA ABG: Metabolic acidosis ECHO: R heart strain
What does a PERC Score contain?
Rule out PE in low risk All factors must be -ve for a -ve PERC score. +ve factor = work up (Well's Score) Age >50 HR >100 O2 sats on room air <95% Unilateral leg swelling Haemoptysis Rx surgery/trauma Prev PE/DVT Exogenous OE
What does the Well’s Score contain?
Stratify pts as low or high risk High risk = imaging Low risk = D-dimer Clinically suspect DVT PE most likely diagnosis Tachycardia >100 Immobilisation >3days OR surgery last 4weeks Malignancy Haemoptysis Hx of DVT/PE in past
How is a PE treated?
LMWH: Dalteparin & Warfarin 10mg Stop LMWH when INR >2 but continue Warfarin Vena Cava filter Thrombolysis: Alteplase
What 3 factors make up Virchows triad?
Venostasis (Immobility, paralysis, AF, congestive HF)
Hypercoagulability (Malignancy, pregnancy, protein C&S deficiency, antithrombin deficiency)
Vessel wall inflammation (trauma, surgery, indwelling catheter)
What is the pathophysiology of pulmonary oedema?
Fluid leaks from pulmonary capillaries into lung interstitium & alveoli
Filtration of fluid exceeds capacity of lymphatics to clear the fluid
