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Respiratory 2 > Surgery / Trauma / Pneumothorax > Flashcards

Surgery / Trauma / Pneumothorax Flashcards

1
Q

Cardiac tamponade

A

Blood in the pericardium - external pressure on the heart.

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2
Q

How does a cardiac tamponade cause death?

A

Causes death due to lack of venous return to the heart rather than blood loss.

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3
Q

What is the treatment for cardiac tamponade?

A

Emergency thoractomy

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4
Q

What makes you suspect cardiac tamponade?

A

Penetrating injury - in the centre of the chest.

Signs of becks triad.

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5
Q

Becks triad

A

Hypotension
Distended neck veins
Muffled heart sounds

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6
Q

How is cardiac tamponade diagnosed?

A

Ultrasound scan

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7
Q

Haemothorax

A

Blood in the pleural space

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8
Q

What are the complications of a haemothorax?

A

Small amounts of blood have no consequence.
Massive blood loss - the main danger is hypovolaemia.
> may cause a tension effect as in a pneumothorax.

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9
Q

Surgical emphysema

A

Surgical emphysema (or subcutaneous emphysema) occurs when air/gas is located in the subcutaneous tissues (the layer under the skin). This usually occurs in the chest, face or neck.

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10
Q

What causes surgical emphysema.

A

Lung injury

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11
Q

What is the treatment for a surgical emphysema?

A

Draining the pneumothorax.

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12
Q

Pneumothorax

A

The presence of air in the pleural space.

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13
Q

What can cause pneumothorax to occur?

A

Pneumothorax can either occur spontaneously, or result from iatrogenic injury or trauma to the lung or chest wall.

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14
Q

What is the difference between a primary and secondary pneumothorax?

A

Primary spontaneous pneumothorax occurs in patients with no history of lung disease.

Secondary pneumothorax affects patients with pre-existing lung disease and is associated with higher mortality rates.

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15
Q

What are risk factors for pneumothorax?

A

Smoking, tall stature and the presence of apical subpleural blebs are risk factors.

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16
Q

Iatrogenic

A

Relating to illness caused by medical examination or treatment.
- in the case of pneumothorax thoracic surgery / biopsy may have caused injury to the chest wall.

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17
Q

What is meant by a closed pneumothorax?

A

Where the communication between the airway and the pleural space seals off as the lung deflates and does not re-open, the pneumothorax is referred to as ‘closed’.

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18
Q

What is meant by a open pneumothorax?

A

Where the communication fails to seal and air continues to pass freely between the bronchial tree and pleural space the pneumothorax is referred to as ‘open’.

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19
Q

What is meant by a tension pneumothorax?

A

Occasionally, the communication between the airway and the pleural space acts as a one-way valve, allowing air to enter the pleural space during inspiration but not to escape on expiration. This is a tension pneumothorax.

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20
Q

How does a tension pneumothorax cause complications?

- what are these complications?

A

Large amounts of trapped air accumulate progressively in the pleural space and the intrapleural pressure rises to well above atmospheric levels. This causes mediastinal displacement towards the opposite side, with compression of the opposite normal lung and impairment of systemic venous return, causing cardiovascular compromise.

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21
Q

What are the most common symptoms of a pneumothorax?

A

Sudden-onset unilateral pleuritic chest pain.

Breathlessness.

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22
Q

What is diagnostic of a pneumothorax in clinical examination.

A

The combination of absent breath sounds and a resonant percussion note is diagnostic of pneumothorax.

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23
Q

How does a tension pneumothorax present on clinical examination?

A

By contrast, in tension pneumothorax there is rapidly progressive breathlessness associated with a marked tachycardia, hypotension, cyanosis and tracheal displacement away from the side of the silent hemithorax.

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24
Q

How does a pneumothorax appear on a chest X-ray?

A

The chest X-ray shows the sharply defined edge of the deflated lung with complete translucency (no lung markings) between this and the chest wall.

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25
Q

What is the treatment for a spontaneous pneumothorax?

A

Spontaneous pneumothorax : invariably associated with underlying lung disease in old age and has a significant mortality. Surgical or chemical pleurodesis is advised in all such patients.

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26
Q

Pleurodesis

A

Pleurodesis is a medical procedure in which the pleural space is artificially obliterated. It involves the adhesion of the two pleurae.

27
Q

What are the treatments for a pneumothorax?

A

Percutaneous needle aspiration.

Intercostal tube drainage may be needed.

28
Q

How is a tension pneumothorax treated?

A

If there is a tension pneumothorax, immediate release of the positive pressure by insertion of a blunt cannula into the pleural space may be beneficial, allowing time to prepare for chest drain insertion.

29
Q

Hemothorax

A

Hemothorax is a collection of blood in the pleural cavity.

30
Q

What is the most common cause of a hemothorax?

A

Hemothorax is usually a consequence of blunt or penetrating trauma.

31
Q

How do heart sounds present in cardiac tamponade?

A

Muffled heart sounds

32
Q

How does a rib fracture present?

A

Presents with point tenderness at the fractured rib and bruising.
Pain can be severe resulting in shallow breathing.

33
Q

What is the treatment for rib fractures?

A

Deep breathing

Pain control - analgesics.

34
Q

What are the complications of rib fractures?

A

Pneumothorax
Hemothorax
Splenic / Liver laceration

Inadequate pain control can lead to atelectasis (lung collapse).

35
Q

What does atelectasis predispose one to?

A

Developing a post-traumatic pneumonia.

36
Q

Flail chest

A

Flail chest is a life-threatening medical condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall.

3 adjacent ribs are fractured in at least two locations.

37
Q

What can flail chest result in?

A

Respiratory failure caused by a pulmonary contusion.

38
Q

Pulmonary contusion

A

A pulmonary contusion, also known as lung contusion, is a bruise of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, potentially leading to hypoxia.

39
Q

What is the presentation of a pulmonary contusion?

A

Pulmonary contusions take a while to develop, and thus the presentation is someone who was initially oxygenating well following a blunt chest trauma but then begins to deteriorate over time.

40
Q

How does a pulmonary contusion appear on chest X-ray?

A

Patchy opacities representing pulmonary oedema and haemorrhage.

41
Q

When does a tension pneumothorax occur?

A

When a pneumothorax forms a one way valve allowing air to enter the pleural space of the lungs but not go out.

42
Q

What is the significance of a tension pneumothorax and breathing?

A

With every breath the tension pneumothorax gets bigger and bigger.

43
Q

How can a tension pneumothorax affect the cardiovascular system?

A

A tension pneumothorax can compress the IVC and right atrium decreasing venous return.
> this decreases overall cardiac output which presents as hypotension, altered mental status and an elevated jugular venous pressure.

> this is known as obstructive shock.

44
Q

How is pneumothorax treated?

A

Needle is inserted between the second and third intercostal space at the midclavicular line.

45
Q

What is an open pneumothorax?

A

“Sucking chest wound” - a pneumothorax that communicates with atmospheric air due to an open chest wound.

46
Q

When does an open pneumothorax occur and why?

A

Occurs when a chest wound is greater than 2/3 of the size of the trachea as air takes the path of least resistance into the lung.

47
Q

Obstructive shock

A

Obstructive shock is a form of shock associated with physical obstruction of the great vessels or the heart itself.
> symptoms of hypotension, altered mental status and elevated JVP.

48
Q

Why does an open pneumothorax not result in obstructive shock whilst a tension pneumothorax does?

A

Air is not trapped in the pleural space and so pressure does not build up.

49
Q

What are the symptoms of a hemothorax?

A

Shortness of breath
Hypoxia
Dullness on percussion
Decreased air entry on auscultation.

50
Q

What is the major concern in hemothorax?

A

Haemorrhagic shock s the pleural space can accommodate a lot of blood.

51
Q

Troponin levels are a marker of what?

A

Cardiac myocyte injury - myocardial injury.

52
Q

What is the main concern with penetrating cardiac injury?

A

Pericardial tamponade

53
Q

Pericardial tamponade

A

Build up of blood in the pericardial space.

54
Q

What effect does pericardial tamponade have on the heart?

A

Limits the filling capacity of the heart - decreasing cardiac output.

Results in Beck’s triad.

55
Q

Beck’s triad

A

Hypotension
Muffled heart sounds
Jugular venous distension

56
Q

What is the treatment for cardiac tamponade?

A

IV fluids to maintain BP
Ultrasound guided pericardiocentesis
Thoracotomy

57
Q

What are the symptoms of injury to the tracheobronchial tree?

A

Hemoptysis
Subcutaneous emphysema
Auscultation - crunching sounds synchronous with pulse.
Wound can open into the pleural space causing a pneumothorax.

58
Q

Hamman’s Crunch

A

Hamman’s crunch is a crunching, rasping sound, synchronous with the heartbeat, heard over the precordium in spontaneous mediastinal emphysema. It is felt to result from the heart beating against air-filled tissues.

59
Q

What does a chest X-ray show when there is injury to the tracheobronchial tree?

A

Pneumomediastinum - air in the mediastinum
Subcutaneous emphysema
Pneumothorax

60
Q

Subcutaneous emphysema

A

Subcutaneous emphysema occurs when gas or air travels under the skin.
> This most often occurs in the skin covering the chest wall or neck

61
Q

What are the symptoms of an inhaled foreign body?

A 
Dyspnea.
Neck or throat pain
Stridor and hoarseness may occur if object is lodged in upper airway (uncommon)
Asymmetric breath sounds
Tachypnea.
Nasal flaring
Cyanosis
62
Q

Subcutaneous emphysema symptoms

A 
Sore throat
Neck pain
Swelling of the chest and neck
Difficulty breathing
Difficulty swallowing
Difficulty speaking
Wheezing
63
Q

Pleuritic chest pain is associated with what condition?

A

Pneumothorax

Respiratory 2 (22 decks)

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