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Medicine: PBL wrap-ups > Unit 4 Case 1: Pneumothorax > Flashcards

Unit 4 Case 1: Pneumothorax Flashcards

1
Q

bacterium in bovine tuberculosis

A

mycobacterium bovis

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2
Q

is tuberculosis a notifiable disease

A

yes

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3
Q

transmission of bovine tuberculosis

A

unpasteurised products
inhaled and infected droplets
direct contact of salvia
urine
faeces

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4
Q

types of tb you can have once infected

A

active or latent

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5
Q

what is a notifiable disease

A

disease by law that must be reported to the government authorities

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6
Q

human tb and bovine tb

A

similar symptoms
clinicians might not be able to tell the difference between the two when presented in people

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7
Q

how to treat Tb

A

rifampicin
isoniazide
pyrazinamide
ethambutol

6 month treatment

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8
Q

what is latent tb

A

not infectious to other a

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9
Q

how do you detect tb

A

x ray
Mantoux test
microscopy of sputum
biopsy

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10
Q

symptoms of tb

A

cough
weight loss
night sweats
high temperature
swelling around your neck

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11
Q

public health impact of TB presence in dairy farming

A

must isolate the infected animals and now allow their products to leave the farm, reduced income
cows have had to be slaughtered to prevent the spread
zoonotic disease

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12
Q

prevention and control measures of bovine TB

A

increased surveillance
post mortem inspection
individual testing
treatment (but is expensive)
badger culling as easily spread by badgers

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13
Q

normal mechanism of inspiration

A

external intercostals contract
diaphragm contracts and flattens
atmospheric pressure is greater than pulmonary pressure
air moves into the lungs
ribs and sternum are elevated, extending the anterior/posteriro dimension of the thoracic cavity
extension of the superior.inferior dimension of the thoracic cavity

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14
Q

normal mechanism of expiration

A

external intercostals relax
diaphragm relaxes
pulmonary pressure is greater than atmospheric pressure
air is forced out of the lungs
depression of the ribs and the sternum, reduces the anterior/posterior dimension of the thoracic cavity
volume of the thoracic cavity decreases

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15
Q

accessory muscles of forced inspiration

A

scalenes
sternocleidomastoid
pectoralis major and minor
serratus anterior

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16
Q

accessory muscles of forced expiration

A

anterolateral abdominal wall
internal intercostals
innermost intercostals

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17
Q

mechanism of paradoxical breathing

A

when the diaphragm moves in the opposite direction to the thoracic cage
as the diaphragm fatigues moves upwards in response to the negative intra-thoracic pressure generated by the inspiratory action of the neck and intercostal muscles
causes chest to contract during inhaling and expand during inhaling

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18
Q

cause of paradoxical breathing

A

diaphragmatic dysfunction

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19
Q

what may give an increased likelihood of paradoxical breathing

A

obstructive sleep apnea
disruption of nerves
mineral deficiency
weak respiratory muscles
obstruction of the chest wall

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20
Q

obstructive sleep apnea

A

disruption of the inflow of oxygen and exhalation of carbon dioxide
eventually chest wall will turn inwards rather than outwards

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21
Q

nerve damage

A

to the phrenic nerves by MS
muscular dystrophy and lung cancer

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22
Q

mineral deficiency

A

potassium
magnesium
calcium

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23
Q

weak respiratory muscles

A

MS and ALS which are neuromuscular conditions

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24
Q

obstruction of the chest wall

A

can separate the ribs
meaning will no longer expand when you inhale
this section can start to push inwards which causes paradoxical breathing

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25
Q

testing for paradoxical breathing

A

fluoroscopy
pulmonary function test
maximal static inspiratory pressure
sniff nasal inspiratory pressure

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26
Q

scans for paradoxical breathing

A

ultrasound
chest x ray
electromyography
CT scan
MRI

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27
Q

treatment for paradoxical breathing

A

treat underlying condition
can prescribe to alleviate the symptoms
nocturnal invasive ventilation
continuous positive airway pressure
surgery
surgical plication
phrenic pacing

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28
Q

testing for resonance

A

Firmly place middle finger over the chest wall along intercostal space ​
Tap chest along interphalangeal joint with middle finger of other hand ​
Tap 2-3 times in a row​
Listen to feel the resonance ​
Percuss all around the chest​
Patient cross arms to shoulder to expose posterior thorax​
Tap top to bottom and compare by percussing corresponding spaces ​
Hands over head and percuss the axilla ​
Move from and percuss anterior chest clavicle and supraclavicular space

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29
Q

normal resonance

A

dullness of left anterior chest due to heart and right lower chest due to liver

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30
Q

hyperresonance of left lower anterior chest

A

due to air filled stomach

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31
Q

increased resonance

A

lung distension in asthma
bullous disease
emphysema
can be due to pneumothorax

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32
Q

when would an air ambulance be used

A

there is a criteria followed called helicopter emergency medical specialist

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33
Q

when else may an air ambulance be used

A

interhospital transfer and non-urgent scene transfer

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34
Q

when will the land ambulance be dispatched alongside the air ambulance

A

to ensure safe movement of the patient to the aircraft
may be weather restrictions
refusal of the patient to fly
flight safety
aggressive patietns

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35
Q

role of the air ambulance

A

can give pre-hospital life saving care to the patient at the scene
crew on board will be capable of life saving procedures such as giving general anaesthetic and open-heart surgery
then take patient to a trauma centre/hosital

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36
Q

what are trauma centres equipped to deal with

A

most serious conditions:
car accident injuries
gunshot wounds
brain injuries
stab wounds
serious falls
blunt traumas

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37
Q

effect of being in a rural environment on emergency medicine

A

long distance from specialist treatment
longer times for ambulances to reach the patient and unequal modern healthcare
reduced primary care services for after emergency treatment
car accidents more likely in rural areas, more serious conditions in hard-to-reach locations
farms in rural areas are associated with increased levels of occupational injury, illness and death

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38
Q

process of a primary trauma survey

A

Airway
breathing
circulation
disability
exposure

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39
Q

airways examination

A

check airways noises
position of head
foreign body
fluid, secretions
oedema

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40
Q

airways intervention

A

open
suction
secure
o2

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41
Q

airways goal

A

patent airway

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42
Q

breathing examination

A

look listen feel
respiratory rate and effort
breath and added sounds
subcutaneous emphysema
symmetry of chest movement
tracheal deviation
jugular vein distension
cyanosis

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43
Q

breathing intervention

A

o2 according to spo2
pneumothorax therapy
inhalation therapy
ventilation

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44
Q

breathing goal

A

sufficient oxygenation and ventilation

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45
Q

circulation examination

A

heart rate
blood pressure
capillary refill time
bleeding
skin colour
blood sample
diuresis

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46
Q

circulation intervention

A

IV/IO access
control of bleeding
massive haemorrhage protocol
fluids
drugs
transfusion

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47
Q

circulation goal

A

stabilisation of circulation

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48
Q

disability examination

A

AVPU/GCS
reactivity and symmetry of pulls
blood glucose levels
basic neurological examination
posture
toxicological examination

49
Q

disability intervention

A

glucose
antidotes

50
Q

disability goal

A

evaluation of neurological state

51
Q

exposure examination

A

head to toe examination
medical history
temperature
injuries
oedemas
scars
signs of drug abuse
skin changes
signs of infection/sepsis

52
Q

exposure intervention

A

identified cause therapy
thermomanagement
trauma treatment
insertion of NGT, IUC

53
Q

exposure goal

A

revealing other symptoms and therm-management

54
Q

who is involved in the trauma team

A

team leader
primary physician
airway team
trauma nurses
radiographer
social worker
scribe
surgeons

55
Q

primary aim of the trauma team

A

to rapidly resuscitate and stabilise patient

56
Q

team leader role

A

uses trauma checklist
allocate roles
ensures PPE is worn prior to arrival of patient
identifies estimated weight
document
handover
primary and secondary survey

57
Q

primary physician role

A

primary and secondary survey

58
Q

airway team role

A

anaesthetist
nurse

59
Q

trauma nurses role

A

ECG
oximetry
BP
IV access
remove clothes
draw blood

60
Q

social worker role

A

talk to the family
provide support/guidance

61
Q

scribe role

A

records time of patient arrival
Jesus steps
vital signs
name of staff in attendance and their roles

62
Q

different types of oxygen masks

A

nasal cannula
Hudson mask
bag valve mask
venturi mask
non-rebreather mask
non-invasive ventilation
invasive ventilation

63
Q

nasal cannula

A

24-30% oxygen
flow rate 1-4L, 2L is most comfortable
used in non-acute situations

64
Q

Hudson mask

A

rarely used
30-40% oxygen
flow rate 5-10L per minute

65
Q

bag valve mask

A

handheld
flow rate 15L per minute

66
Q

venturi mask

A

delivers 24-60% oxygen
different colours for different flow rates
blue 2-4
white 4-6
yellow 8-10
red 10-12
green 12-15

67
Q

non-rebreathe mask

A

85-90% o2
15L flow rate
bag contains valves to prevent rebreathing of expired air
used for acutely unwell patients

68
Q

2 types of non-invasive ventilation

A

continuous positive airways pressure
bilevel positive airways pressure

69
Q

continuous positive airways pressure

A

high pressure air/oxygen with a tight fitting mask
positive pressure all the time to keep airways open
used in acute pulmonary oedema and sleep apnoea

70
Q

bilevel positive airways pressure

A

high positive pressure on inspiration and lower positive pressure on expiration
used on exacerbations of COPD and ARDS

71
Q

what is the definition of a pneumothorax

A

air in the pleural cavity
between the parietal and visceral pleurae resulting in lung collapse

72
Q

primary spontaneous pneumothoraces

A

usually occur due to rupture of the pleural bleb

73
Q

secondary spontaneous pneumothoraces

A

occur in due to pre-existing diseases
e.g. COPD, infection, cystic fibrosis

74
Q

traumatic pneumothorax

A

result of a blunt or penetrating trauma

75
Q

what are the types of pneumothorax

A

primary spontaneous
secondary spontaneous
traumatic

76
Q

pleural bleb

A

small collection of air between the lung and the visceral pleura usually found in the upper lobe of the lung
due to sub pleural alveolar rupture and congenital defects in connective tissue of alveolar walls

77
Q

what is COPD

A

chronic obstructive pulmonary disease
includes emphysema and chronic bronchitis

78
Q

iatrogenic pneumothoraces

A

traumatic pneumothoraces caused by clinical instrumentation to the thorax

79
Q

describe a tension pneumothorax

A

high pressure air accumulates in the intrapleural space and isn’t able to completely exit during expiration putting pressure on and displacing the mediastinum
causes lung to collapse on ipsilateral side
pressure increases it causes the mediastinum to shift to the contralateral side, contributes to hypoxemia

80
Q

symptoms of patients with a pneumothorax

A

chest pain, worsens when breathing
breathlessness
mild symptoms and pneumothorax of less than 2cm will be discharged and out patient follow up

81
Q

testing for a pneumothorax

A

plain chest x ray
ct scan
ultrasound

82
Q

what is in the image

A

pneumothorax

83
Q

when may a chest x ray not be useful in diagnosing a pneumothorax

A

if there is a small pneumothorax
or the air is collecting anteriorly it may be missed

84
Q

when may a CT scan be used for a pneumothorax

A

to produce a more detailed image
to find the cause or diagnose a pneumothorax that may not have been spotted by x ray

85
Q

what will an ultrasound of a pneumothorax show

A

grainy below the pleural surface in a healthy individual due to lung movement
however, in an individual with a pneumothorax lung sliding would be invisible due to air blocking transmission of the ultrasound wave

86
Q

what is a flail chest segment

A

when 3 or more ribs are broken in at least 2 places
causes a segment of the chest wall ti move independently of the rest of the chest wall

87
Q

normal ph of blood

A

7.35-7.45

88
Q

normally paO2

A

75-100 mmHg

89
Q

normal PaCO2

A

35-45mmHg

90
Q

normal value of HCO3

A

22-26 mEq/L

91
Q

normal O2 sats

A

95-100%

92
Q

metabolic acidosis

A

decreased pH
increased H+
primary disturbance is decreased HCO3-
secondary response is decreased pCO2

93
Q

metabolic alkalosis

A

increased pH
decreased H+
primary disturbance increased HCO3-
secondary response is increased pCO2

94
Q

respiratory acidosis

A

decreased pH
increased H+
primary disturbance increased pCO2
secondary response increased HCO3-

95
Q

respiratory alkalosis

A

increased pH
decreased H+
primary disturbance decreased pCO2
secondary response decreased HCO3-

96
Q

causes of tracheal deviation

A

tension pneumothorax
pleural effusion
mediastinal goiter
pleural fibrosis
atelectasis
pulmonary fibrosis
pneumonectomy
mediastinal lymphoma

97
Q

what is a chest drain

A

flexible tube inserted through the chest wall into the pleural cavity
through the 5th intercostal space
guided using real time ultrasound

98
Q

risks/side effects associated with a chest drain

A

pain
failure of procedure
bleeding
infection
damage to surrounding structures
pneumothorax

99
Q

what is a chest drain used to do

A

remove air/fluid from pleural space
prevent air/fluid returning to the pleural space
restore negative pressure in the pleural space

100
Q

what are the two types of drain

A

seldinger
surgical

101
Q

seldinger chest drain

A

commercially packed kit
needle and syringe inserted into chest cavity
air aspirated to confirm needle is within the pneumothorax
guide wire inserted
needle removed
skin incision made around wire
dilated passed over guide wire
dilater removed
drain inserted over guide wire
guide wire removed

102
Q

surgical chest drain

A

incision made with scalpel, 2-3 cm
curved blunt dissecting instrument used to go through tissues down to the parietal pleura
finger sweep using index finger
place drain
secured with non-absorbable sutures and a purse string stitch
drain connected to underwater seal drainage bottle so air doesn’t re-enter and can apply suction to drain
chest x ray done to confirm correct positioning

103
Q

types of mechanical ventilation

A

negative pressure
positive pressure

104
Q

negative pressure ventilation

A

attempts to mimic functions of respiratory muscles
applies sub atmospheric pressure outside of chest to inflate the lungs

105
Q

advantages of negative pressure ventilation

A

upper airway can be maintained/no need for endotracheal tube
patients can talk and eat
fewer psychological disadvantages

106
Q

disadvantages of negative pressure

A

abdominal venous blood pooling
primarily replaced by positive pressure ventilators (mask, nasal device, tracheostomy tube)

107
Q

positive pressure ventilation

A

mechanical ventilator moves air into patients lungs via an endotracheal tube or mask
inflating pressure during respiration (proximal airway) equals the sum of pressure required to overcome the compliance of the lug and chest wall and the resistance of the airway

108
Q

2 types of positive pressure

A

positive end-expiratory pressure
continuous positive airway pressure

109
Q

treatment options for pneumothorax

A

needle aspiration
chest drain
supplemental oxygen therapy
non-surgical repairs
surgery

110
Q

complications of intubation

A

upper airway trauma
tooth displacement
injury to mouth, throat, vocal cords and trachea
sinusitis
tracheal narrowing
tissue death
infection
pneumonia
sepsis

111
Q

complications of ventilation

A

alveoli rupture
lung collapse/pneumothorax.
oxygen toxicity
pneumonia
medication side effects
ventilator malfunction
inability to wean off ventilation

112
Q

to give consent what must you be able to do

A

understand, remember, use it and communicate that decision
where it is not possible to gain consent, doctors should provide treatment that is in the patients best interests
can include to save a life or avoid a significant deterioration to the patients health

113
Q

main painkillers and sedations

A

opioids are medicines used to treat pain
work by attaching receptors in the brain and spinal cord, gut and other parts of the body
lowers the feeling for pain

114
Q

weak opioids

A

codeine and dihydrocodeine

115
Q

strong opioids

A

tramadol
methadone
diamorphine
morphine
fentanyl
oxycodone

116
Q

emotional and psychological responses to trauma

A

denial
anger
fear
sadness
guilt
hopelessness
irritability
anxiety
depression
may have emotional outbursts
flashbacks and nightmares
trauma can also cause physical symptoms such as headaches, fatigue, sweating, feeling jumpy and racing heart
hyperarousal

117
Q

what is PTSD

A

anxiety disorder triggered by a terrifying event
may start 1 month after or years after event

118
Q

4 groups of PTSD symptoms

A

intrusive memories
avoidance
negative changes in thinking and mood
changes in physical and emotional reactions

119
Q

psychological impact of PTSD on family

A

sympathy
negative feelings
avoidance
depression
anger
guilt
health problems

Medicine: PBL wrap-ups (21 decks)

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