Test 4

Question 1

what do ribs do on inspiration and expiration in flail chest?

Answer 1

cave in on inspiration and bulge out on expiration

Question 2

flail chest definition

Answer 2

double fractures of at least 3 or more adjacent ribs

Question 3

what are some things that flail chest can cause?

Answer 3

atelectasis, pendalluft, pulmonary contusions, hemorrhaging and damage to underlying organs

Question 4

what is a pendulluft?

Answer 4

air is shunted from one lung to the other which causes the compressed gas from affected lung to move to unaffected side, which causes patient to rebreathe dead space gas

Question 5

what happens to the pao2 and RR in flail chest?

Answer 5

pao2 decreases and RR increases

Question 6

alteration of lungs in flail chest

Answer 6

lung restriction (low lung volume), pneumothorax, lung contusion, rib instability

Question 7

causes of flail chest

Answer 7

MVA, falls, blast injury

Question 8

treatment of flail chest in mild and severe

Answer 8

mild- meds and bronchial hygiene
severe- stabilize chest, vent with peep, bone healing takes 5-10 days
also, o2 therapy and lung expansion

Question 9

definition of pneumothorax

Answer 9

gas accumulates in the pleural space and the visceral and parietal pleura separate

Question 10

what are the pressure gradients in a tension pneumo?

Answer 10

intrapleural pressure > intraalveolar (atmospheric) pressure

Question 11

what happens in a tension pneumo?

Answer 11

gas enters on inspiration but can’t escape on expiration, puts pressure on heart, decreases CO

Question 12

alterations in lungs in a pneumothorax

Answer 12

lung collapse, atelectasis, chest wall expansion, compression on great veins

Question 13

symptoms of a pneumo

Answer 13

sudden onset, severe dyspnea with chest pain, cough, cardiovascular collapse, potential hemoptysis

Question 14

change in trachea in pneumo

Answer 14

trachea shifts to the unaffected side (away from the pneumo) and chest appears larger

Question 15

what is the tell tale sign of a pneumo in an xray?

Answer 15

deep sulcus sign on supine chest xray
costophrenic angles are abnormally deep when pleural air collects laterally

Question 16

what are the 3 classifications of pneumos?

Answer 16

traumatic (wounds), spontaneous (caused by underlying issue) and iatrogenic (caused by therapy)

Question 17

who are most likely to get a spontaneous pneumo?

Answer 17

tall and thin people (15-35 years old)

Question 18

what happens in a piercing chest wound?

Answer 18

a traumatic pneumo will cause one way valve-like action

Question 19

what is always a hazard to cause a pneumo in the hospital?

Answer 19

positive pressure mechanical vent

Question 20

what is the treatment for a small pneumo vs a large?

Answer 20

small- bed rest bc reabsorption occurs within 30 days
large- air need evacuated

Question 21

what is the evacuation process of a less severe pneumo and a serious pneumo?

Answer 21

less severe- needle aspiration/decompression
serious- thoracostomy chest tube

Question 22

what can help manage pneumos and pleural effusion?

Answer 22

pleurodesis- a chemical or med is injected into the chest cavity which causes lungs to stick to the chest cavity

Question 23

2 parts of pulmonary embolism

Answer 23

thrombus- blood clot in vein
embolus- blood clot that travels to another part of the body

Question 24

what is a saddle embolus?

Answer 24

a large embolus that passes through the right side of the heart and lodges in the pulmonary artery. it is quickly fatal

Question 25

alterations of the lungs in a PE

Answer 25

pulmonary hypertension, pulmonary infarction, alveolar atelectasis and consolidation, bronchospasm

Question 26

causes of PE

Answer 26

blood clots are most common, most break away from deep venous thrombi in the lower part of the body also, fat, air, amniotic fluid, bone marrow or tumor fragments

Question 27

what is dvt formation called?

Answer 27

virchow triad

Question 28

risk factors of PE

Answer 28

surgery, trauma, venous stasis, hypercoagulation, unhealthy lifestyle

Question 29

signs and symptoms of a PE

Answer 29

sudden SOB, sudden hypotension, chest pain , anxiety, cough with blood streaked sputum

Question 30

what does an xray typically look like with a PE

Answer 30

often normal

Question 31

what is a hamptons hump?

Answer 31

seen in an xray with a PE, it is a wedge shaped opacification

Question 32

what is the first line test for PE?

Answer 32

spiral cat scan, single breath hold, only takes 20 seconds

Question 33

PE and V/Q

Answer 33

dead space disease = well ventilated but poorly perfused (paCO2 problem) shunt = blood passes through lung without gas exchange (PaO2 problem)

Question 34

what test is performed for a PE when all others fail?

Answer 34

pulmonary angiogram

Question 35

what is the most important thing when treating a PE?

Answer 35

treat the symptoms and treat quickly o2, pain meds, fluids, BP meds

Question 36

what 2 drugs can be used together to treat PE?

Answer 36

warfarin and heparin

Question 37

what is a thrombolytic used for in PE?

Answer 37

dissolve blood clot (clot busters)

Question 38

what is a pleural effusion and an empyema

Answer 38

fluid accumulates in the pleural space and an empyema is when the fluid becomes infected

Question 39

early signs and symptoms of a pleural effusion

Answer 39

chest pain with intense inflammation, chest pressure, dyspnea, cough

Question 40

causes of pleural effusion

Answer 40

chf, malignancy, pneumonia, PE

Question 41

what is a chylothorax?

Answer 41

milk fluid caused by trauma to the neck or thorax

Question 42

what is the difference between transudative and exudative?

Answer 42

trans is fluid from pulmonary capillaries that move into the pleural space and exu is when the pleural spaces are diseased

Question 43

what is the difference in fluid in trans and exu?

Answer 43

trans- thin and watery, benign and non inflammatory exu- high protein content and inflammatory and infected

Question 44

what is the most common cause of transudative pleural effusion?

Answer 44

CHF

Question 45

what are some causes of exudative pleural effusions?

Answer 45

diseases of the GI tract, mesothelioma, empyema, TB

Question 46

how is the trachea shifted in a pleural effusion?

Answer 46

shifts to the affected side, away from the effusion

Question 47

what will you hear in a chest of someone with a pleural effusion?

Answer 47

decreased tactile and vocal fremitus and dull percussion notes

Question 48

what will you see on an xray of someone with a pleural effusion?

Answer 48

blunting of costophrenic angles, depressed diaphragm, mediastinal shift to unaffected side