Chest Pain 2 Flashcards
(38 cards)
What type of people does pneumothorax tend to affect?
Tall, young, healthy people. Also associated with smoking, Marfan’s disease, alpha-1 antitrypsin deficiency and changes in atmospheric pressure.
Describe pain from a pleural disease and why it’s like that.
Pleural pain is VERY, VERY PAINFUL. The pain is usually sharp and precise. Why? Because the pleura is somatically innervated.
What enters the pleural space when you have pneumothorax? What do most patients have with this affliction?
Air. Most patients have a bleb: a collection of air within the layers of the visceral pleura. Blebs are places where the lung has rotted as a result of emphysema, which leaves huge holes in the lung that are vulnerable to popping and leaking air.
What is increased in tension pneumothorax?
Intrapleural pressure.
True or false: many patients with pneumothorax are asymptomatic.
TRUE. Especially those with COPD.
Patients with what affliction tend to have a high mortality with pneumothorax?
COPD.
During tension pneumothorax, increases in pressure above central venous pressure will result in what?
Decreased venous return and hypotension.
How should tension pneumothorax be diagnosed?
Clinically.
Describe the presentation of tension pneumothorax.
Subcutaneous air, tracheal deviation, shock, severe respiratory distress, early morning discovery.
What are some presentations of pneumothorax?
Chest pain which is pleuritic, subacute course, mild dyspnea, decreased breath sounds unilaterally, tympanitic hemithorax, absent tactile fremitis, Hamman’s crunch.g
What are the presentations of pleural effusion?
Pleural effusions may be asymptomatic, but can also cause: chest pain, dyspnea, decreased breath sounds, dullness to percussion and mediastinal shift (in large effusions).
Which chest x-ray, AP or lateral, requires more fluid to accumulate before being visible on film?
AP. You need 500 ccs vs 200 ccs for lateral. This is because there exists a deep sulcus laterally that allows for greater visibility, whereas the fluid on the AP film is also lined behind the liver.
How can you detect a free flowing effusion on x-ray?
Have the patient lie down on his side. If the lung opens up, the pleural effusion is free flowing.
What can be done to both diagnose and treat pleural effusion?
Thoracentesis. This can ONLY be done with ultrasound guidance.
Empyemas are most commonly caused by which organisms?
Staph, strep and Gram negative organisms.
What can empyemas occur after?
Pneumonia, lung infarction, resection or abdominal infection.
What two things should lead you to suspect an empyema?
Fever and pleural effusion.
How do you treat an empyema?
With antibiotics and drainage.
What is a sign of pneumomediastinum on imaging?
If you can see the two diaphragms coming all the way to the vertebrae, with no heart in the middle, it means that the mediastinum is filled with air.
What are risk factors for thrombotic emboli?
Trauma, immobilization, cancer, surgery, birth control pills.
What is a sign in imaging that could aid in the diagnosis of a pulmonary emboli?
Hampton’s hump.
What are three examples of ischemic heart disease?
Myocardial infarction, angina pectoris and heart failure.
What is a strong prognosticator of death in chest pain?
Congestive Heart Failure
Are infarcts always symptomatic?
No. About 1/4-1/3 of all infarcts are silent.
