Pneumothorax and Pulmonary Embolism Flashcards Preview

Respiratory > Pneumothorax and Pulmonary Embolism > Flashcards

Flashcards in Pneumothorax and Pulmonary Embolism Deck (12):
1

What is the definition of a pneumothorax and what are the causes?

- Air within the pleural cavity

- Traumatic, iatrogenic (biopsy, TBLB, aspiration) and spontaneous (primary - healthy, and secondary - underlying lung disease)

2

Why is tension pneumothorax so dangerous and how is it treated?

- Increased intrapleural pressure

- Venous return impaired, CO and BP fall, and PEA arrest occurs

- Venflow in 2nd intercostal space in midclavicular line to relieve pressure

3

What is the pathophysiology of primary spontaneous pneumothorax?

- Development of blebs/bullae at lung apices caused by gravity due to lower intrapleural pressure in apices

- When blebs burst this leaves a tear in the visceral pleura

4

What is the pathophysiology of secondary spontaneous pneumothorax?

- Inherent weakness in lung tissue

- Increased airway pressure

- Pressure gradient leads to lung collapse

5

What are the diagnostic features of spontaneous pneumothorax?

- Signs and symptoms include pleuritic chest pain, breathlessness, respiratory distress, reduced air entry of affected side, hyper-resonance to percussion, reduced vocal resonance and tracheal deviation if tension

- CXR looks for lack of lung markings and pleural line away from the edges of the pleural spaces

- <2m small and >2cm large

6

How is spontaneous pneumothorax managed?

- Observation if small

- Aspiration

- Intercostal drain with underwater seal

- VATS if not resolved after 5 days

7

What is the pathophysiology of pulmonary embolism?

- Obstruction of the pulmonary arteries by a clot from the veins of the systemic circulation

- More than 90% from DVT in pelvis or legs

- Acute changes invlove increased vascular resistance, RV strain, right to left shunting through PFO and increase in alveolar-arterial gradient

- Compensation involves lysis of clot, recovery of RV function, decreased perfusion in poorly ventilated areas and decreased surfactant in obstructed zones causing atelectasis

8

What are the risk factors for pulmonary embolism?

- Surgery < 12 weeks previously

- Immobilisation >3 days in previous 4 weeks

- Previous DVT/PTE

- FHx

- Long distance travel

- Oestrogen OCP use

- Protein S deficiency

- Protein C deficiency

- Factor V Leiden

- Prothrombin G20210A

- Hyperhomocysteinaemia

9

What are teh signs and symptoms of pulmonary embolism?

- Pleuritic chest pain

- Dyspnoea

- Cough

- Haemoptysis

- Tachypnoea

- Crackles

- Tachycardia >100bpm

- Fever

- Syncope

- Signs of peripheral DVT

10

What investigations are used for pulmonary embolism?

- D-dimer (rased >230mg/L)

- ABG (respiratory alkalosis, hypoxaemia)

- Troponin level

- ECG (sinus tachycardia, RV strain, SI-QIII-TIII)

- CXR

- CT-pulmonary angiogram

11

What are the factors of the Modified Geneva Predictive Risk Score for pulmonary embolism?

- Age >65yrs (1)

- Previous DVT/PE (3)

- Recent surgery in part month (2)

- Malignant disease in last year (2)

- Unilateral lower limb pain (3)

- Haemoptysis (2)

- HR 75-94bpm (3)

- HR ≥95bpm (5)

- Pain in deep venous palpation of leg and unilateral oedema (4)

12

How is pulmonary embolism treated?

- For massive PE (BP <90mmHg or drop >40mmHg in <15 mins) give unfractionated IV heparinm fluids and thrombolysis with alteplase

- For sub-massive PR give LMWH then oral anticoagulation for 3 months