THORAX / HEART FINAL Flashcards
anesthesia injection
-anesthesia of any particular area of skin usually requires injection of two adjacent nerves
-ex. anesthesia for broken rib requires injection of anesthetic agent into region of intercostal nerves superior and inferior to rib, proximal to site of fracture
muscles use during breathing
-forced:
-inspiration- external intercostal muscles
-expiration- internal intercostal muscle and rectus abdominus sheath
-dyspnea:
-recruitment of neck muscles
-sternocleidomastoid, pecs, upper trapezius, scalene muscles
-normal expiration is governed by elastic recoil pulmonary
atelectasis
-pleural cavity (normally potential space) becomes real space
-intercostal space narrowing
-displacement of mediastinum toward affected side
-when air enters pleural cavity visceral and parietal layers detach -> elastic recoil
-perfusion no ventilation
-more common on right side
-not taking deep breathes
-alveoli fill with junk
-subsegmental collapse of lung due to mucus plugging
- bronchial breath sounds heard in periphery (instead of vesicular)
lymph in lungs
-carry phagocytes
-ingest carbon particles from inspired air
-smokers -> mottled gray
subclavian artery compression
-apex of lung
-scalene muscles
-supernumerary C7 rib
-thoracic outlet syndrome -> costoclavicular syndrome
lesser diaphragmatic apertures
-2 in right crus of diaphragm- transmit greater and lesser right splanchnic nerves
-3 in the left crus of diaphragm- transmit greater and lesser left splanchnic nerves as well as hemiazygos vein
-under the medial arcuate ligament- usually transmit sympathetic trunks
-under lateral arcuate ligament- subcostal nerve and vessels
-left phrenic nerve pierces dome of the left hemidiaphragm
-internal mammary artery thorough sternal costal gaps
rib movement / percussion
-water pump
-increase/decrease anterior posterior diameter of lungs according to diaphragm
-percuss it posteriorly to measure -> diaphragmatic migration
-phrenic nerve pace maker for diaphragm paralysis
-C 3, 4, 5 keep the diaphragm alive
numbing of spinal nerves
-numb posterior region around spine when pt has significant nerve pain
-allows patient to breathe deeply -> prevents pneumonia and atelectasis
-catheter two fingers away from midline that infuses fluid with LONG acting anesthetic
-ancupump (grenade)
dead space
area of lung ventilating but not perfused -> no gas exchange
shunting
area of perfusion but no ventilating -> blood is passing by with no gas exchange
VQ
-interface between alveoli and capillary
-VQ ventilation perfusion
-areas of lung that are ventilating need to be perfused -> gas exchange
-gas exchange doesnt happen until level of bronchial
left internal thoracic artery
-internal mammary artery
-used for bypass conoid
-comes off the left subclavian
blood supply to lungs
-pulmonary and bronchial supply
-rarely infarct!
thorax imaging
-costophrenic angle -> blunt -> pleural effusion
-costocardiac angle
-costocardiac triangle -> where IVC enters RA -> area can become cystic -> pericardial cysts
-costophrenic- sharp angle
-left costophrenic angle is lower due to heart weighing it down
-blunt angle -> pleural effusion
-Ds method- circle aortic knob -> 45 degree angle -> midline -> carina
kehrs sign
-pt laying down with legs elevated
-referred pain to tip of left shoulder
-sign of fluid / blood in cavity
-often spleen damage
-this is bc diaphragm is innervated by superior nerves
left upper lobe pneumonia
-heart loses silhouette due to obscured by left UPPER lobe pneumonia involving the lingula lobe
-left low lobe pneumonia -> density in back of heart -> Still can see cardiac border
-lower lobe lesion is located retrocardiac
tension pneumothorax
-tear in parenchyma -> pleura leaks
-air collects -> pneumothorax
-pressure increases so high -> shifts to contralateral side -> displaces mediastinum -> kink off vena cava -> decrease return -> no blood to heart -> tension pneumothorax
-heart shifts to unaffected side
-no breath sounds on that side
-clinical diagnosis
-bleb pops can cause
-FIRST decompress with thoracocentesis (midclavicular 2nd space) -> simple pneumothorax
-then chest tube
pneumothorax + pleural effusion x-ray
-would show has a flat line of fluid collection on imaging
-meniscus line suggests just pleural effusion
right lower lobe pneumonia
-mimics appendicitis due to T10 dermatome
T4
nipple line
T7/T6
xiphoid process
tension pneumothorax vs atelectasis
-pneumothorax pushes away
-atelectasis- pushes towards
pancoast tumor
starts at apex of lung
Paradoxical Embolism (PDE)
-occurs when a thrombus crosses an intracardiac defect into the systemic circulation.