Pneumothorax, effusion + acute resp failure Flashcards
(64 cards)
What is:
Sharp, localized, fleeting pain exacerbated by coughing, deep breathing, movement, sneezing
Radiation to ipsilateral shoulder
pleuritis
What does this cause:
Acute inflammation of parietal pleura: bacterial, viral, or fungal infection/pneumonia
PE/ lung cancer
Lupus, metastatic cancer, mesothelioma
pleuritis
How do you Dx pleuritis?
CXR - rule out other causes
How do you treat pleuritis?
NSAIDs, codeine, other opioids
Sudden onset of chest pain, dyspnea, cough, life-threatening or respiratory failure
pneumothorax
What are risk factors for pneumothorax?
Drug use, increased pressure (diving, flying), airway disease, infection, lung disease
What does this PE indicate:
Decreased breath sounds
Hyperresonance
Decreased or absent tactile fremitus
Mediastinal or tracheal deviation = tension
Increased JVP, pulsus paradoxus, HOTN
pneumothorax
What type of pneumothorax: : no pre-existing lung disease
tall, thin boys + men 10 - 30 years w/ smoking + family hx
primary spontaneous pneumothorax
What type of pneumothorax: pre-existing lung disease
more life-threatening, COPD, asthma, interstitial lung disease, TB, pneumocystis pneumonia
secondary spontaneous pneumothorax
What type of pneumothorax: penetrating trauma, lung infections, CPR, + pressure mechanical ventilation
life-threatening, organs pushed to contralateral side
tension pneumothorax
For unstable patients what imaging do you pick for a pneumothorax?
rapid bedside imaging w/ US: lung point, absence of lung sliding
For stable patients what imaging do you pick for a pneumothorax?
CXR (TOC), showing visceral pleural line (companion lines), deep sulcus sign
CT, if dx is uncertain, loculated pneumothorax, or further trauma
A small pneumothorax is <_
2 cm
A large pneumothorax is _
> / 2 cm
What values of the average intrapleural distance dictate a small or large pneumothorax?
<15% small, 50% large
What’s the first step for pneumothorax?
stabilize patient
- RR <24
- HR>60 but <120
- normal BP
- O2>90%
- ability to speak in whole sentences
What is treatment for a small primary pneumothorax?
6 hour observation
Repeat CXR to confirm no progression
Follow up in 24 hours
What’s treatment for a large primary pneumothorax?
Needle aspiration followed by chest tube (second intercostal space at midclavicular line of the affected side) if fails
Attach to heimlich valve to prevent tension
What’s treatment for a secondary pneumothorax?
Chest tube placement (large, severe, or from mechanical ventilation) + hospitalization
Thoracostomy (recurrence, bilateral, failure)
How do you treat a tension pneumothorax?
Medical emergency → emergent chest decompression with a large-bore needle followed by immediate chest tube placement
What can be seen as asymptomatic or pain referring to shoulder from pleural inflammation and dyspnea, cough?
pleural effusion
What does this PE indicate:
absent or diminished movements on affected side
Fullness of chest w/ bulging intercostal spaces
Diminished breath sounds
decreased/absent tactile fremitus
Dullness to percussion
Absence of breath sounds
Absent vocal resonance
Pneumonia-like findings (crackles)
pleural effusion
associated w/ bacterial pneumonia, bronchiectasis, or lung abscess
parapneumonic
anatomically confined within a sac
loculated effusion