Thorax Flashcards

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

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
How would a tension pneumothorax present
``` Chest pain Dyspnoea Distended neck veins Tracheal deviation Tachycardic and hypotensive ```
26
How is an open pneumothorax managed
Russel dressing
27
How is a tension pneumothorax managed
Needle thoracostomy | Chest tube placement in the safe triangle
28
What is the management of retroperitoneal aortic rupture
EVAR
29
What is an aortic dissection
Separation of the intima leading to a false lumen within the media
30
How does an aortic dissection present
Acute tearing or ripping chest pain BP difference in the arms Pulse deficit
31
How is an aortic dissection managed
IV labetalol | EVAR
32
What are the ECG criteria for coronary reperfusion
ST elevation >2mm in 2 standard or 2 adjacent precordial (chest) leads not including V1 LBBB in patients with other features suggestive of ACS