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PHM BSc - Applied Science > Thorax > Flashcards

Thorax Flashcards

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1
Q

Where does pain from the parietal peritoneum travel and hence where is it felt

A

Travels along phrenic nerves

C3,4,5 dermatomes and supraclavicular area

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2
Q

What can happen to the aorta in a deceleration incident

A

Rupture at the aortic isthmus as this is the junction of mobile to immobile
Arch is immobile due to main branches and ligamentum arteriosum

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3
Q

What is a cardiac tamponade

A

Accumulation of fluid in the pericardial space that compresses the heart causing reduced diastolic filling and therefore reduced SV

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4
Q

What can cause cardiac tamponade

A

Penetrating trauma
Aortic dissection
Cardiac wall rupture post MI

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5
Q

How does a cardiac tamponade present

A

Muffed heart sounds
Hypotension
Distended neck veins
Dyspnoea
Chest pain
Kussmauls sign (paradoxical rise in JVP on inspiration)
Pulses paradoxus (systolic BP drops >10 on inspiration)
Ewarts (bronchial breathing due to left lower lung compression)

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6
Q

What does the ECG show in cardiac tamponade

A

Low voltage QRS complexes that can vary in height from beat to beat

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7
Q

How is a cardiac tamponade managed

A

Pericardiocentesis - needle inserted at border of xiphisternum and L rib border aiming for ipsilateral scapula
Thoracotomy

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8
Q

What do changes in leads 1, AVL, V5 and V6 suggest

A

Lateral MI (left circumflex)

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9
Q

What do changes in leads 2,3 and AVF suggest

A

Inferior MI (RCA)

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10
Q

What do changes in leads V1 and V2 suggest

A

Septal MI (LAD)

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11
Q

What do changes in leads V3 and V4 suggest

A

Anterior MI (LAD)

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12
Q

Which type of MI is associated with bradycardia and why

A

Inferior

Because the RCA supplies the conducting system of the heart

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13
Q

How is an MI managed

A 
Morphine 10mg IV
Oxygen
Nitrates (Sublingual GTN spray)
Aspirin 300mg oral
Clopidogrel 300mg oral
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14
Q

What are the coronary reperfusion options for a patient with an MI

A

PCI or fibrinolsis

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15
Q

Describe what happens in PCI

A

Femoral (2cm below inguinal ligament) or radial (2cm proximal to radial styloid process) are used
Seldinger technique is used with a balloon catheter being placed over the guide wire

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16
Q

What are the complications of PCI

A 
Pseudoaneurysm (between tunica media and adventitia)
Retroperitoneal haemorrhage (if using femoral)
Dissection
17
Q

What drug is used for fibrinolysis

A

Reteplase

18
Q

What are the indications for a lung/hilar twist and how it is done?

A

Severe lung trauma causing haemorrhage
Divide the pulmonary ligament and anteriorly rotate the lower lobe over the upper lobe to twist and occlude the hilar vessels

19
Q

Where should a chest drain be inserted

A

Triangle of safety (pec major, lat dorsi, 5th intercostal space)
On top of the rib (neurovacular bundle sits underneath)

20
Q

What layers do you go through when inserting a chest drain

A

Skin, subcutaneous fat, external, internal and innermost intercostals, endothoracic fascia, parietal pleura

21
Q

What is a flail chest

A

3 or more adjacent ribs are fractured in 2 or more places leading to paradoxical movement of this segment

22
Q

How does a flail chest affect breathing

A

Hypoventilation due to pain
Underlying pulmonary contusions with bleeding and oedema impairing gas exchange
Increased dead space

23
Q

What is a pneumothorax and the consequence

A

Air in the pleural space leads to a loss of negative pressure between parietal and viscera pleura so the lung collapses

24
Q

Compare the 3 types of pneumothorax

A

Closed - lung or bronchus rupture. Pleural cavity pressure < atmospheric pressure
Open - chest wound with air circulating freely. Pleural cavity pressure = atmospheric pressure
Tension - air enters pleural cavity on inspiration but cannot exit. Pleural cavity pressure >atmospheric pressure

25
Q

How would a tension pneumothorax present

A 
Chest pain
Dyspnoea 
Distended neck veins 
Tracheal deviation
Tachycardic and hypotensive
26
Q

How is an open pneumothorax managed

A

Russel dressing

27
Q

How is a tension pneumothorax managed

A

Needle thoracostomy

Chest tube placement in the safe triangle

28
Q

What is the management of retroperitoneal aortic rupture

A

EVAR

29
Q

What is an aortic dissection

A

Separation of the intima leading to a false lumen within the media

30
Q

How does an aortic dissection present

A

Acute tearing or ripping chest pain
BP difference in the arms
Pulse deficit

31
Q

How is an aortic dissection managed

A

IV labetalol

EVAR

32
Q

What are the ECG criteria for coronary reperfusion

A

ST elevation >2mm in 2 standard or 2 adjacent precordial (chest) leads not including V1
LBBB in patients with other features suggestive of ACS

PHM BSc - Applied Science (12 decks)

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