Trigger - pleural diseases Flashcards
which pleura contains pain fibers
the parietal pleura
when would you see chest pain with radiation of pain to ipsilateral scapula
pleuritis affecting diaphragmatic pleura
when would you see a pleural friction rub
pleuritis caused by PE
when would you see peripheral edema and orthopnea
pleurisy caused by CHF
aso see paroxysmal nocturnal dyspnea
when would you see paroxysmal nocturnal dyspnea
pleurisy cuased by CHF
also see orthopnea and peripheral edema
what occurs when a patient no longer has chest pain but has now developed a worse cough and SOB
pleuritis that became a pleural effusion
apparently pleuritic chest pain can be present but it lessens a bit
what absorbs pleural fluid to maintain homeostasis
the lymphatics of the PARIETAL pleura
how much fluid is in the pleural space
5-15mL
the term for fluid rich in cells and protein that goes through vessels during inflammation
exudates
the term for watery solution with no protein or cells that passes through vessels due to pressure imbalance (natural)
transudate
what would cause symptoms of hemoptysis, night sweats, fever and weight loss in presence of pleuritic CP, cough and dyspnea
pleural effusions caused by TB
pleural effusions with hemoptysis and weight loss can also be caused by malignancy!
pt presents with pleuritic chest pain, cough, dyspnea, fever and purulent sputum
pleural effusion caused by pneumonia
if the trachea is displaced to the right which side is the pleural effusion
left side
a patient has S3 gallop and JVD with associated dullness to percussion and decreased lung sounds
pleural effusion d/t CHF
a patient has ascites with associated tracheal deviation to the left side and dullness to percussion on the right side
pulmonary effusion d/t liver disease
may also present with jaundice
a patient has LAD with associated decreased tactile fremitus and decreased chest expansion on the right side
right sided pleural effusion d/t malignancy
may also see a palpable mass with malignancy
costophrenic blunting is seen with what
pleural effusions of >175ml or 6oz
CXR shows deviation of bronchi, loculation along fissures and chest wall and costophrenic blunting
pleural effusion
may also see air bronchogram!!
what imaging results suggests a need for thoracentesis in pleural effusion
loculation
in a patient with recurrent effusions, what treatment is used
pleurodesis
a patient who smokes and has no underlying lung disease has a pneumothorax. what type is this?
primary spontaneous pneumothorax
can be an early indicator of lung disease!
affects mainly tall, thin males between 10-40 years old
primary spontaneous pneumothoraces
fam hx is a big risk factor!
(so is smoking)
what type of pneumothorax is known to be associated with menstruation/endometriosis
secondary spontaneous pneumothoraces
(known as catamenial pneumothoraces, occurs 72 hours before or after menstruation)
a patient with a known hx of COPD now has developed a pneumothorax. what type is this?
secondary spontaneous pneumothoraces.
(remember this is pneumothorax as a complication of a preexisting pulmonary disease)
if a patient develops a pneumothorax secondary to a healthcare intervention such as biopsy, ventilation or thoracentesis, what type of pneumothorax is it
iatrogenic pneumothorax
pneumothorax d/t CPR or positive pressure ventilation can be described as what type of pneumothorax
tension pneumothorax AND iatrogenic pneumothroax
which category of pneumothoraces is life threatening
tension pneumothoraces
tachypnea, brady/tachycardia, abnormal BP and o2 sat <90% are all vital signs associated with what diagnosis
pneomothoraces
tachypnea is associated with which diagnosis
pneumothorax
aslo see:
dyspnea, SOB, pleuritic chest pain (mild/severe)
with small pneumothoraces what may be the only PE finding
mild tachypnea!
a patient presents with severe respiratory distress. They are unable to speak in full sentences and have marked tachycardia and hypotension. what is occuring?
tension pneumothorax
presents with tracheal deviation, displacement of PMI and respiratory distress
tension pneumothorax
what is the treatment for a person with no hx of pneumothorax currently presenting with small pneumothorax (<2cm) with no pleural effusion and stable vital signs
O2 at 6L with goal of SpO2 >96% and repeat CXR in 6 hours.
(must meet all these criteria for oxygenation:
- small pneumothorax (3cm or less at apex or 2cm or less at hilum)
- stable vital signs
- first PSP
- no pleural effusion)
a patient with no previous hx of pneumothorax presents with a
large pneumothorax (4cm) and stable vital signs. what is the treatment
aspiration IF a provider with expertise is present.
all must be present for aspiration:
- large pneumothorax (3cm or greater at apex, 2cm or greater at hilum)
- stable vital signs
- first PSP
- provider with expertise in aspirations
where is aspiration performed
2nd ICS in midclavicular line
what is an indication for chest tube during aspiration?
lack of resistance to aspiration after 4L removed
where is a thoracostomy placed?
4th or 5th ICS in anterior axillary or midaxillary line
this type of pneumothorax is NEVER observed! always maintain airway and do thoracostomy
secondary spontaneous pneumothorax
needle decompression is used in which pneumothorax
tension pneumothorax
where is needle decompression done?
2nd anterior ICS between at midclavicular line
or
5th ICS anterior or midaxillary line
