Week 2 - Thorax

Question 1

If inserting a chest drain would you go above or below the rib ?

Why ?

Answer 1

You insert above the Rib

Underneath is a nuerovascular bundle which increases the risk of bleeding.

Question 2

Which side is the diaphragm higher on?

Why is this ?

Answer 2

Right hand side

The liver takes up room

Question 3

Which nerve supplies the diaphragm ?

Answer 3

Phrenic nerve (C3, C4, C5)

Question 4

What treatment would you give to a patient with a rib fracture.

Answer 4

Appropriate pain relief to prevent pneumonia

Question 5

What is a flail chest ?

Answer 5

- Life threatening condition

- 3 or more ribs broken at at least 2 places

- likely impending respiratory failure

- intubation and surgery are likely

Question 6

How would you treat a flail chest ?

Answer 6

- Analgesia

- PCA / nerve block

- Anaesthesia + PPV ( positive pressure ventilation )

- ORIF ( open reduction internal fixation)

Question 7

Why would you use PPV ( positive pressure ventilation) in flail chest ?

Answer 7

Flail segment will go up rather than in