Guided study pre MSA Flashcards
(96 cards)
1
Q
why are chest tubes used?
A
to remove are or fluid from the pleural space or mediastinum
2
Q
hazards?
A
things which have the potential to cause harm
3
Q
risk?
A
probability that harm will occur
4
Q
how do you reduce hazards and risks?
A
- by adopting hazard reduction methods
- blocking asses to them
5
Q
4 ways to manage risks?
A
- mitigate risks
- protect ourselves
- deny risks access
- indemnify
6
Q
define the thoracic inlet?
A
a bony ring, formed by the first thoracic vertebra, the first rib and the manubrium sterni
7
Q
define boundaries of the thoracic outlet?
A
1- posteriorly by the 12th thoracic vertebrae
2- posterolaterally by the 11th and 12th pairs of ribs
3- anterolaterally by the joined costal cartillages of ribs 7-10
4- anteriorly by the xiphisternal joint
8
Q
what does the first costal cartilage articulate with?
A
articulates with the manubrium through primary cartilaginous joints that do not allow movement.
9
Q
what are the major surface land marks of the thoracic viscera?
A
10
Q
what happens with age to the first costal cartilage?
A
it becomes ossified, meaning that the net is relatively rigid and contraction of the intercostal muscles will result in lower ribs being raised towards the inlet.
11
Q
what are the different types of joints in the thorax?
A
12
Q
in the neck, what structure lies in the midline anteriorly?
A
trachea
13
Q
in the neck, what group of muscles lies on either side of the trachea?
A
strap muscles
14
Q
mid clavicular line?
A
lies half way between the sternoclavicular and the acromioclavicular joints, both of which are easily palpable
15
Q
what structure lies on either side of the midline structure?
A
common carotid arteries, internal jugular veins
16
Q
1- mid axillary line
2- mid scapular line
3- parasternal
4- precordium
A
1- lies midway between the axillary folds
2- drawn inferiorly from the inferior angle
3- means on either side of the sternum
4- refers to the anterior chest
17
Q
where is the superior border of the sternum
A
jugular/sternal notch
- lies between the insertions of the right and left sternocleidomastoid muscles and lies at the level of the intervertebral disc between T2 and T3
18
Q
what marks the joint between manubrium and body of the sternum and level of second costal cartilage ?
A
sternal angle
- lies at the level of the disc between vertebrae T4&5
19
Q
where will you find the xiphisternal joint?
A
at the level of the disc between T8 and T9
20
Q
what are the structures that lie behind the manubrium of the sternum?
A
- the structures in the superior mediastinum
- thymus
- brachiocephalic veins and SVC,
aortic arch - oesophagus
- phrenic nerve
- vagus and left recurrent laryngeal nerves
- sympathetic trunks
21
Q
what are the structures that lie at the level of the sternal angle?
A
- the azygos veins enter the SVC
- ascending aorta becomes the arch
- the arch then becomes the descending aorta
- the ligamentum arteriosum lies just inferior to the aortic arch
22
Q
describe the spinous processes of thoracic vertebrae?
A
- they are long and overlap each other that the tips of the processes lie below the level of the bodies of the other vertebrae.
23
Q
what is the surface landmark used to locate the 2nd rib?
A
sternal angle
24
Q
which vertebral spinous process is a useful landmark when attempting to count vertebrae?
A
C7
25
what dermatome is typically related to the sternal angle?
T2
26
what dermatome is related to the nipple
T4
27
What dermatome is typically related to the xiphioid process?
T7
28
What dermatome is typically related to the umbilicus?
T10
29
what dermatome is related to the suprapubic region?
T12
30
How is air drawn into the thoracic cavity?
an increase in volume will reduce pressure in the thorax and will cause air to be drawn into the thoracic cage.
31
where does the central tendon of the diaphragm lie in relation to the ribs?
- the domes of the diaphragm move with respiration and posture
- the central tendon moves slightly too
- it has a variable position with T8/9 vertebra and the 7th ribs costal cartilage anteriorly
32
are the Demi facets present on all thoracic vertebra?
only on the vertebra that articulate with the typical ribs, so T1,10,11 and 12 do not have Demi facets.
33
for which rib is the sternal angle a land mark?
2
34
what creates the costovertebral joint?
- the apex articulating with the intervertebral disc and the lateral edges articulate with the Demi facets of the adjacent vertebral bodies forming the costovertebral joint.
35
where will you find the manubrium and body of sternum
T3 and T4
T5-T0
36
angle of loius?
useful landmark for accurately counting the number of ribs, lying opposite to the intervertebral disc between vertebrae T4and T5
37
skeletal muscle?
- attached to bones
- obvious striations
- rich capillary supply
- no gap junctions
38
what is different about smooth muscle calcium regulation in comparison to the other 2 types?
skeletal and cardiac = troponin and actin containing filaments
smooth = calmodulin in the sarcoplasm
39
what is the difference in connective tissue components between the 3 types of muscle fibres?
- skeletal muscle = 3 connective tissue components: epimysium, perimysium, endomysium
- cardiac= endomysium attached to fibrous skeleton of heart
- smooth = endomysium
40
do any of the 3 types of muscle have myofibrils composed of sarcomeres?
skeletal muscle = yes
cardiac muscle = yes but irregular thickness
smooth = no, but actin and myosin filaments are present
41
do any of the 3 muscle types have t-tubules?
skeletal = yes
cardiac= yes
smooth = no- only calveoli
42
what is the difference In respiration use for the 3 types of muscle?
skeletal = aerobic and anaerobic
cardiac = aerobic
smooth = mainly aerobic
43
cardiac muscle
- intermediate between striated and smooth
- continuous involuntary rhythmic contraction of the heart
- gap junctions
44
smooth muscle?
- spindle shaped
- centrally placed nucleus
- loose connective tissue surrounds the muscle fibres
- gap junctions
45
in what structure does blood return from the placenta to the foetus?
the umbilical vein
46
in which vessel does blood from the umbilical vein bypass the liver?
the ducts venosus
(between 25-50% of the blood will bypass the liver)
47
what vessel does the ductus venosus drain into?
the inferior vena cava
48
1- which chamber does oxygenated foetal blood first enter?
2- through which right to left shunt does the majority of blood from the inferior vena cava pass?
1- right atrium
2- Forman ovale
49
which right to left shiny connects the pulmonary trunk to the aorta?
how?
ductus arteriosus
due to high resistance in the non functioning lungs increases the pressure in the pulmonary circulation helping to force the blood into the aorta through the ductus.
50
1- what will the umbilical artery become?
2- what will the umbilical vein become?
1- medial umbilical ligament
2- ligamentum teres hepatis
51
what processes increases systemic vascular resistance, resulting in increased left sided pressure?
clamping the umbilical cord
(closing the umbilical cord)
52
what process causes the pulmonary resistance to drop, resulting in a decrease in right sided pressure?
first breathe
53
what are the anatomical landmarks associated with the insertion of a central line?
the needle should be inserted at the triangle's apex formed by the sternocleidomastoid muscle's two heads above the medial clavicle and is usually 5 cm superior to the clavicle. The needle should be inserted at 30 to 45 degrees into the skin.
54
most common sites for a central line insertion?
internal jugular vein
subclavian vein
usually on the right side
(femoral and external jugular vein may also be used buts less common)
55
after a vein has been located what happens?
a guided wire is passed through the needle into the vein
the cannula or catheter is is then passed over the guide wire into the vein.
the guided wire can be removed
56
what does it mean, "most central lines are multi lumen"?
they have multiple cannulae and connections running through one larger sheath, this allows for different fluids and drugs to be given at the same time whilst the CVP is being measured from a different connection
57
what will a low CVP indicate?
indicates that the venous return to the heart is less than it should be, as may occur in hypovolaemic shock or dehydration
58
what does a high CVP indicate?
right heart failure which may be due to a number of different conditions
59
what are the reasons why a central line would be inserted?
- measurement of central venous pressure
- administration of drugs that would damage smaller veins (like chemo)
- needs to obtain venous access when peripheral drains have shut down
- administration of high Flow fluids
- ease of administration if access is likely to be needed for several days
60
what are the possible complications associated with the insertion of a central line?
- puncturing the apex of the lung
- puncturing major vessels (haemothorax)
- damage to thoracic duct if placing the line on left
- introducing air into circulation causing and embolism
- if inserted in unsterile conditions then introducing infection into body
- damage to anomalous venous valves which may result in thrombus formation
61
what is a central line?
a large catheter or cannula inserted into one of the larger veins in the body in which the tip of the cannula may lie in either the superior or inferior vena cava or the right atrium
62
what is a normal CVP?
6-8 cm H20
or
4.5-6 mmHg
63
what is the link between central venous pressure and the internal jugular pressure?
Elevated CVP will present clinically as a pulsation of the internal jugular vein when a patient is inclined at 45 degree
Elevated CVP is indicative of myocardial contractile dysfunction and/or fluid retention.
64
what leads look at the heart in a vertical cross section?
I
II
III
avR
AVL
aVF
65
what leads look at the heart in a horizontal cross section?
V1-V6 (the ones across the chest)
66
cardiac tamponade?
happens when fluid accumulates in the pericardial sac, resulting in a decrease in CO
67
how to calculate heart rate?
count the number of large boxes between successive QRS complexes and divide into 300
68
why are P waves on aVR inverted?
because you are looking from the right shoulder
- the P wave commences at the SA node and does down the AV node away from aVR, hence the P wave in inverted
69
what leads are looking at the inferior aspect of the heart?
leads III and aVF
70
what is the cardiac axis?
this is the average direction of spread of the depolarisation through the ventricles when viewed from the front.
(if you imagine a clock face, this is usually from 11 to 5 o'clock)
you work out the axis from looking at the limb leads
71
what is the usual range for cardiac axis?
-30 to +90
72
what are possible sources of contamination of blood cultures?
patients
the environment/ equipment
clinicians obtaining the blood sample.
73
what are the consequences of blood culture contamination?
1- increased stay in hospital
2- false postive/ negative
3- increased risk of clostridium difficile infection due to expi=osure of antimicrobial agents.
74
prior to obtaining a blood culture sample, what do you need to discuss with the patient?
1- ensure the blood culture is indicated
2- explain and discuss the procedure of obtaining a blood sample
3- gain consent
75
what vein will you eat to use to take blood from?
media cubital vein
cephalic vein
basilic vein
76
what are the 5 moments for hand hygiene?
- before touching a patient
- before clean/aseptic procedures
- after bodily fluid exposure
- after touching a patient
- after touching patient surroundings.
77
what colour should the broth in the blood culture be?
GREEN
- if it is orange or red this will be an indication of prior contamination and thus bottle should not be used.
78
when preparing to obtain a blood culture, how long do you clean the bottle tops and the skin for?
- you are required to clean the patients skin for 30 secs using isopropyl alcohol swab, then let the area dry for 30 secs.
- once the plastic cap of the blood culture bottle has been removed, you must clean the rubber top for 30 seconds using a 70% isopropyl alcohol swab.
79
in what order should blood samples be collected?
1- blood culture bottles (aerobic then anaerobic)
2- coagulation tubes
3- tubes with no additives
4- other tubes with additives
80
which blood culture bottle do we use first and why?
aerobic bottle first as there may be air in the tubing, air entering the anaerobic will impede the growth of the aneroid organism.
81
how much blood is required for a blood sample?
8-10 pls of blood to each culture
82
what are blood cultures?
this is a specific microbiological test that is carried out on a sample of blood to identify infection that is caused by a micro organism, specifically bacteria or yeast.
83
what will a blood culture set consist of?
two bottles
1 will be designed to enhance the growth of aerobic organisms and the other the growth of anaerobic organisms.
84
what can over filling lead too?
- over filling can lead to false positives because of the carbon dioxide that is generated by excessive white cells
- one millilitre of blood can increase the sensitivity of the blood culture by 3%
85
histologically, what would you expect to see in ACUTE MI up to 18 hrs?
no changes
86
histologically, what would you expect to see in ACUTE MI up to 24-48hrs?
macroscopic features= pale oedematous muscle
microscopic changes = oedema, neutrophil infiltration, necrosis of myocytes
86
histologically, what would you expect to see in ACUTE MI up to 2-4 days?
macroscopic features= yellow, rubbery centre with hemorrhagic border
microscopic features = obvious necrosis and inflammation, early granulation tissue
86
histologically, what would you expect to see in ACUTE MI up to 1-3 weeks?
macroscopic features = infarcted area paler and thinner than unaffected ventricle
microscopic features = granulation tissue then progressive fibrosis
87
histologically, what would you expect to see in ACUTE MI up to 3-6 weeks?
macroscopic changes = silvery scar becoming tough and white
microscopic features= dense fibrosis
88
what colour will the vessels appear that are injected with contrast medium
bright white
89
what is the difference between hypoxia and hypoxaemia?
Hypoxemia is defined as a decrease in the partial pressure of oxygen in the blood whereas hypoxia is defined by reduced level of tissue oxygenation.
90
what organ is most sensitive to oxygen changes?
brain
91
what are the 5 vital signs?
Body temperature
Pulse or heart rate
Respiratory rate
Blood pressure
Oxygen level/saturation (SpO2)
92
what is the recommend oxygen prescribed for acutely ill patients?
94-98%
93
what is the recommended target oxygen prescribed for those patients at risk of hypercapnic respiratory failure?
88-92%
94
where should the ball of a flow meter devise sit to correctly deliver the required amount of oxygen?
the bottom of the flow tube
