Week 9 Flashcards
what is a pneumothorax?
the presence of air or gas in the pleural space caused by a disruption in the visceral/parietal pleura and the chest wall
what is a spontaneous pneumothorax?
pneumothorax that occurs without any obvious cause of trauma
what is the difference between a primary and secondary spontaneous pneumothorax?
primary - occur without recognised lung disease
secondary - occur due to a recognised lung disease
what pressure does the pleural space have in relation to atmospheric pressure?
4-8mmHg below atmospheric pressure
What are the characteristics of patients who get primary spontaneous pneumothorax?
usually 18-40
tall, thin and are often smokers
What are the risk factors of primary spontaneous pneumothorax?
smoking genetics lung disease mechanical ventilation previous pneumothorax
What is the most common cause of secondary spontaneous pneumothorax?
COPD
What are the risk factors for secondary spontaneous pneumothorax?
tall thin males copd or asthma smoking family history marfan syndrome exposure to loud music in those at risk for SP
what are the signs and symtoms of spontaneous pneumothorax
SOB decreased breaths sound over affected area pleuritic chest pain increase WOB Increase ETCO2 initially Decrease ETCO2 late Low SpO2 Lower LOC Hypotension Subcutaneous emphysema
how long does complete resolution of an uncomplicated pneumothorax take?
approx 10 days
when is recurrence of pneumothorax most likely?
within 6 months - 3 years of initial.
what is the most common cause of Pulmonary embolysm?
blood clot in a vein - DVT
What are risk factors for PE?
- Varicose veins
- oral contraceptive pill
- Oestrogen therapy
- Vasculitic syndromes (lupus, behcets syndroms)
- pregnancy
- haematological disease (polycythaemia)
- Age
- AF
WHat is the triad that indicates how a blod clot forms?
VIRCHOWS TRIAD
- stasis
- vessel wall injury
- hypercoagulopathy
when should you consider a PE?
any patient with sudden onset of cardiovasular decompensation, syncope, unexplained hypoxia, shock and or PEA cardiac arrest
what does a PE lead to physiologically
hypoxaemia by increasing anatomical and phsiological dead space
- increase in pulmonary vascular resistance leading to right ventricular wall ternsion
- RV dysfunction or AMI
what is a demarcation line?
cyanotic head and neck and chest from nipples only.
indicates PE
what should you do when suspecting PE?
head to toe - check legs!
look for size, colour, temp and pain
WHAT ARE SIGNS AND symptoms of PE?
- chest pain (under breastbone, sharp/stabbing/burning/aching/dull/heavy
- pain gets worse with deep inhalation
- pt may bend over or hold chest during pain
- cyanosis
- poor Pa02 level
- dizziness/lightheaded/fainting/coma
- fast breathing and wheezing
- tachycardia
- anxiety
- leg pain redness and swelling
- low BP
- sudden cough, possibly coughing up blood
- SOB that starts suddenly
- CPC skin
what ECH changes do you see in PE?
- Sinus tachy
- complete or incomplete RBBB
- Right axis deviation
- RV strain pattern
- S1 Q3 T3 - deep s wave in lead 1, large Q wave in lead 3, inverted T in lead 3.
Explain S1 Q3 T3
S1 Q3 T3 - deep sluured s wave in lead 1, large Q wave in lead 3, inverted T in lead 3.
Sign of pulmonary embolism
What leads do you use to look for RBBB and LBBB?
V1 and V6
William Marrlow
What is the rule out criteria for PE?
HAD CLOTS
H - hormone - no oestrogen or progenancy A - <50 D - DVT/PE - no previous history C - coughing up blood L - leg swelling O - Sats >95% T - tachycardia <100 S - surgery in last 28 days
what is a pleural effusion?
abnormal build of fluid in the pleural space. resulting from excess production of fluid or decreased reabsorption of fluid.
