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GAP 2018 > TPT Signoff > Flashcards

TPT Signoff Flashcards

1
Q

Definition of pneumothorax

A

The presence of air between the visceral and parietal pleura causing compression and displacement of the lung.

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2
Q

Definition of tension pneumothorax

A

A life threatening accumulation of air in the pleural space secondary to damage to the visceral or parietal pleura, which creates a one-way valve. This causes lung collapse on the affected side and compression of heart and major vessels.

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3
Q

Patho of simple pneumothorax

A
  • non-expanding collection of air in the pleural cavity

- does not require decompression if not compromising oxygenation

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4
Q

Patho of spontaneous pneumothorax

A
  • spontaneous rupture of a bleb allows air to enter the pleural space
  • Primary: occurs in healthy individuals with no associated trauma
  • Secondary: occurs in pts with lung disease
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5
Q

Patho of tension pneumothorax

A
  • air enter pleural space through a tissue flap/hole in visceral or parietal pleura
  • hole acts as a one way valve allowing air to enter on inspiration but becomes trapped on expiration
  • causes increased pressure in pleural space and loss of negative pressure hence causing the lung to collapse
  • as pressure increases with mediastinal shift, major vessels are compromised
  • decreased VR from IVC and SVC causes reduced CO
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6
Q

Patho of Iatrogenic pneumothorax

A
  • develops secondary to medical intervention which allows air into pleural space
  • caused by cardiac compressions and IPPV
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7
Q

Patho of open pneumothorax

A
  • occurs with injury to chest wall allowing air to move freely between atmosphere and pleural space
  • if injury is larger than normal airway pathway, air will travel through the wound during inspiration rather than the trachea
  • air moves into pleural space during inspiration and our the wound on expiration causing a sucking chest wound
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8
Q

Hard signs of TPT

A
  • decreased conscious state
  • decreased BP
  • stiff bag
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9
Q

Soft signs of TPT

A
  • unequal breath sounds
  • resp distress or worsening distress in setting of chest trauma
  • poor perfusion
  • subcutaneous emphysema
  • tracheal shift
  • low spo2
  • increased JVP
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10
Q

Treatment of TPT - who to stab

A
  • deteriorating conscious state and decreasing BP
  • deteriorating conscious state and progressive resp distress in trauma
  • stiff bag on attempted PPV
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11
Q

Treating trauma pt

A

-pt with mechanism of injury who is deteriorating, bilateral decompression

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12
Q

Treating asthmatic pt

A

-allow 1min apnoea before attempting decompression

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13
Q

Perform unilateral chest decompression if:

A

location of the TPT is obvious

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14
Q

Perform bilateral decompression if:

A
  • pt presents in immediate life threat
  • injury may have involved both sides
  • unclear which side injury has occurred
  • always decompress right side first
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15
Q

Insertion site for decompression

A 
Second intercostal space 
Midclavicular line
Above the rib below
Right angles to chest
Towards the spine
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16
Q

Why do we stab where we do?

A
  • intercostal arteries run along the bottom of each rib
  • major subclavian vessel located above the second rib
  • mammary artery lies close to sternum
17
Q

Steps in identifying correct insertion site

A
  1. expose pts chest
  2. locate distal end of clavicle
  3. palpate along clavicle to suprasternal notch
  4. palpate down sternum to angle of louis, second rib runs laterally
  5. palpate along 2nd rib to midclavicular line
  6. palpate down third rib
  7. identify second intercostal space, midclavicular line
  8. mark insertion site
18
Q

Problem: no release of air

A
  • ensure correct location
  • cannula may be too short, apply gentle downward pressure
  • if no release, leave cannula in situ and reattempt laterally
19
Q

Problem: cannula too short

A

MICA

20
Q

Problem: blood released

A

Haemothorax

Remove cannula, cover the wound and mark insertion site

21
Q

Problem: symptoms redevelop after decompression

A
  • can be due to blood clot or tissue, or kinked cannula
  • draw 5ml saline into a syringe
  • attach and pull back on syringe
  • no effect, flush the 5ml through syringe
  • if no effect, remove cannula and reinsert in either the same site or laterally

GAP 2018 (13 decks)

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