Respiratory emergency Flashcards
Definition of pleural effusion
abnormal accumulation of fluid in pleural cavity.
Not a diagnosis, an indicator of a pathologic process that may be in origin.
Definition of hemothorax
Accumulation of blood in pleura space
Name the 3 types of Pleural effusion.
1) transudative pleaural effusion
2) Exudative pleural effusion
3) hemothorax.
list examples of transudative pleural effusion
- cardiac failure
2) hypoalbuminemia
Name examples of exudative pleural effusion
bacterial pneumoniass
TB
uremia
causes of haemothorax
traumatic:
- blunt trauma
- penetrating trauma
Nontraumatic:
- neoplasia
- blood dyscrasia
- PE with infarction
- torn pleural adhesions in association with spontaneous penumothorax.
Definition of neoplasia
uncontrolled/ abnormal growth of cells/ tissues in the body
What is the difference between small effusions and large effusions? for pleural effusions.
small: min. of 300mls in the pleural cavity to be seen in xray
large: interferes with lung expansion with reduction in vital capacity
hypoxia and hypercapnia.
clinical features of pleural effusion. small and large.
1 general.
1 small.
4 large
acute pleural pain, dyspnea
small effusion:
no findings
large effusions:
decreased chest movement
shift of mediastinum structure
dullness on percussion and absent breath sounds
what is thoracostomy
chest tube placement
what is the treatment for hemothorax if it is equal or greater than the amt required to obscure the costophrenic sulcus
thoracostomy
when should surgical exploration for traumatic haemothorax be considered?
- massive haemothorax: greater than 1000ml of blood is evacuated immediately after thoracostomy
- bleeding from chest continues 150-200mls for 2-4 hours
- persistent blood transfusion required to maintain haemodynamic stability
what is pneumothorax?
collection of air in pleura cavity
types and causes of pneumothorax
Spontaneous
Rupture of bulla(e) on surface of lungs
Bronchial asthma, COPD, tuberculosis
Chest trauma
Negative pleural pressure will allow air to enter
clinical features of pneumothorax:
almost similar as haemothorax/
Asymptomatic in small pneumothorax
Acute pleural pain, dyspnea in large pneumothorax
Decreased chest movements
Shift of mediastinal structures
Hyper-resonance on percussion and absent breath sounds
what is tension pneumothorax?
Life-threatening condition
The accumulation of
air under pressure in the pleural space.
Associated with formation of a one-way valve at
point of rupture in the lung
Air becomes trapped in pleural cavity and builds up
Prevents lung from inflating fully
complications of pneumothorax:
1) Venous return and cardiac output decrease with
hypotension and tachycardia
2) Hypoxemia due to alveolar collapse
3)Reexpansion pulmonary edema
Occurs following rapid lung reexpansion particularly:
From low lung volumes
Long duration pneumothorax
High pressure gradient across lung
May be related to reperfusion injury
Lung reexpansion should be slow
* First, just waterseal, no suction
* If lung fails to reexpand, then apply suction
4)DEADLY - Bronchopleural fistula (BPF)
is a sinus tract between the main stem, lobar, or
segmental bronchus and the pleural space
WHAT IS Bronchopleural fistula and why isit deadly?
a sinus tract between the main stem, lobar, or
segmental bronchus and the pleural space
, allows continuous flow of air entry into the pleural space, making things worse.
how to diagnose pneumothorax?
Chest radiography
– Requires good quality film
– In ICU, 30% of pneumothoraces are missed due to:
* Low-quality film
* Supine position of patient on AP film
* Air hidden behind thoracic or mediastinal structures
2) Radiographic appearance
Mediastinal shift, diaphragmatic depression, flattened ribs
3) CT may be used to confirm size and presence of
pneumothorax.
management of pneumothorax: SOS
- Oxygen
– Should be administered to all patients
– Supplemental O 2 speeds absorption of air from pleural space - Observation of stable patients
– Primary: observe 4 hours, if no enlargement: home
– Secondary and iatrogenic: hospitalize and observe carefully,
* If there is any deterioration (SpO 2 , RR, etc) - drain - Simple aspiration
– Small catheter placed in pleural space
– Connect to three-way stopcock
– Slowly evacuate until no more air can be removed
– This works as many leaks heal between time of leak and its
drainage.
– If 4 L air is removed without resistance, chest tube placement is
required
4.Chest tubes
– Resolution is mostly determined by lung healing
– Small bore: placed via small incision in second intercostal space
(ICS), midclavicular line or laterally, fifth–seventh ICS
* Connected to underwater seal or Heimlich valve
– Large bore: placed via blunt dissection, usually connected to
“three-bottle” chest drainage system
– Chest tubes are sutured in place
5.Pleurodesis: consider with recurrent
pneumothoraces
Pleurodesis is a procedure per formed to obliterate the pleural
space to prevent recurrent pleural ef fusion or pneumothorax or
to a treat persistent pneumothorax .
where are chest tubes usually inserted in terms of anatomical positions?
second intercostal space
(ICS), midclavicular line or laterally, fifth–seventh ICS
Pleurodesis:
procedure to stick your lung to the chest wall.
PULMONARY EDEMA
Life threatening emergency in which excess fluid
accumulates in lungs
Characterized by extreme breathlessness
Due to alteration of capillary forces in the alveolar wall
causes of pulmonary edema
1) ↑ Venous hydrostatic pressure
LVF (most common cause)
2. ↓ Plasma osmotic pressure
Hypoalbuminemia
- Altered alveolar capillary membrane
permeability
Acute respiratory distress syndrome (ARDS
