Pneumothorax, effusion + acute resp failure Flashcards

(64 cards)

1
Q

What is:
Sharp, localized, fleeting pain exacerbated by coughing, deep breathing, movement, sneezing

Radiation to ipsilateral shoulder

A

pleuritis

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2
Q

What does this cause:
Acute inflammation of parietal pleura: bacterial, viral, or fungal infection/pneumonia
PE/ lung cancer
Lupus, metastatic cancer, mesothelioma

A

pleuritis

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3
Q

How do you Dx pleuritis?

A

CXR - rule out other causes

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4
Q

How do you treat pleuritis?

A

NSAIDs, codeine, other opioids

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5
Q

Sudden onset of chest pain, dyspnea, cough, life-threatening or respiratory failure

A

pneumothorax

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6
Q

What are risk factors for pneumothorax?

A

Drug use, increased pressure (diving, flying), airway disease, infection, lung disease

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7
Q

What does this PE indicate:
Decreased breath sounds
Hyperresonance
Decreased or absent tactile fremitus
Mediastinal or tracheal deviation = tension
Increased JVP, pulsus paradoxus, HOTN

A

pneumothorax

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8
Q

What type of pneumothorax: : no pre-existing lung disease
tall, thin boys + men 10 - 30 years w/ smoking + family hx

A

primary spontaneous pneumothorax

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9
Q

What type of pneumothorax: pre-existing lung disease
more life-threatening, COPD, asthma, interstitial lung disease, TB, pneumocystis pneumonia

A

secondary spontaneous pneumothorax

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10
Q

What type of pneumothorax: penetrating trauma, lung infections, CPR, + pressure mechanical ventilation
life-threatening, organs pushed to contralateral side

A

tension pneumothorax

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11
Q

For unstable patients what imaging do you pick for a pneumothorax?

A

rapid bedside imaging w/ US: lung point, absence of lung sliding

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12
Q

For stable patients what imaging do you pick for a pneumothorax?

A

CXR (TOC), showing visceral pleural line (companion lines), deep sulcus sign
CT, if dx is uncertain, loculated pneumothorax, or further trauma

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13
Q

A small pneumothorax is <_

A

2 cm

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14
Q

A large pneumothorax is _

A

> / 2 cm

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15
Q

What values of the average intrapleural distance dictate a small or large pneumothorax?

A

<15% small, 50% large

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16
Q

What’s the first step for pneumothorax?

A

stabilize patient
- RR <24
- HR>60 but <120
- normal BP
- O2>90%
- ability to speak in whole sentences

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17
Q

What is treatment for a small primary pneumothorax?

A

6 hour observation
Repeat CXR to confirm no progression
Follow up in 24 hours

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18
Q

What’s treatment for a large primary pneumothorax?

A

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

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19
Q

What’s treatment for a secondary pneumothorax?

A

Chest tube placement (large, severe, or from mechanical ventilation) + hospitalization
Thoracostomy (recurrence, bilateral, failure)

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20
Q

How do you treat a tension pneumothorax?

A

Medical emergency → emergent chest decompression with a large-bore needle followed by immediate chest tube placement

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21
Q

What can be seen as asymptomatic or pain referring to shoulder from pleural inflammation and dyspnea, cough?

A

pleural effusion

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22
Q

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)

A

pleural effusion

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23
Q

associated w/ bacterial pneumonia, bronchiectasis, or lung abscess

A

parapneumonic

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24
Q

anatomically confined within a sac

A

loculated effusion

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25
accumulation of fluid between lung and diaphragm
subpulmonic effusion
26
increased hydrostatic or decreased oncotic pressures (CHF, atelectasis, renal/liver disease)
transudative pleural effusion
27
leaky capillaries from infection, malignancy, trauma
exudative pleural effusion
28
A pleural effusion is classified by:
1) site 2) type 3) mechanism
29
Protein <.5 LDH <.6 LDH <⅔ upper limit of normal for serum LDH
transudative pleural effusion
30
Protein >.5 LDH >.6 LDH > ⅔ upper limit of normal for serum LDH
exudative pleural effusion
31
Increased WBC count pleural effusion
empyema
32
Pleural fluid: blood ratio >.5
hemothorax
33
Light's criteria purpose
If any are true, pleural effusion is EXUDATIVE
34
protein >.5 serum LDH >.6 pleural LDH > 2/3
light's criteria -- exudative
35
elevated amylase in pleural effusion
pancreatic disease, malignancy, esophageal rupture
36
elevated triglycerides in pleural effusion
chylothorax from thoracic duct disruption
37
How do you diagnose pleural effusion?
CBC - leukocyte counts CXR: initial TOC PA: need fluid to diagnose, blunting of costophrenic angle (meniscus sign), diaphragm + heart poorly demarcated, shifts to uninvolved side Lateral decubitus: smaller effusions, free flowing vs. loculated - best CT scan: if minimal or loculated, US or CT for loculated or empyema
38
pleural effusion TOC
chest xray
39
What's the gold standard for diagnosis of pleural effusion
thoracentesis
40
For all acute effusions + differentiation --
Analyze protein, LDH, pH, WBC, glucose, cytology, Gram stain Glucose <60 = TB, malignancy, rheumatoid arthritis, parapneumonic effusion Thoracentesis
41
How do you treat a transudative pleural effusion?
treat underlying cause, diuretics + sodium restriction
42
How do you treat an exudative pleural effusion?
drainage w/ consideration for placement of indwelling pleural catheter (pleurodesis for refractory >2 or 3)
43
How do you treat an empyema?
antibiotics + drainage
44
How do you treat a hemothorax?
drainage
45
What type of acute respiratory failure is: Dyspnea, tachypnea, tachycardia, peripheral or central cyanosis Restlessness, confusion, AMS Tripoding, inability to lie supine, manifestations of stress response (HTN, diaphoresis), use of accessory muscles
hypoxic
46
What type of acute respiratory failure is: Dyspnea + HA = classic Peripheral + conjunctival hyperemia, HTN, tachycardia, tachypnea, impaired consciousness, papilledema, myoclonus (spasms), asterixis COPD exacerbation - reduced air movement, wheezing, squeaking, rhonchi Acute asthma - wheezing, retractions Pulmonary edema - crackles
hypercapnic
47
Respiratory dysfunction resulting in abnormalities of oxygenation or ventilation enough to threaten the function of vital organs
acute respiratory failure
48
arterial hypoxemia caused by inflammatory lung injury or severe hypoventilation w/ escalating need for supplemental oxygen, acute or chronic From pneumonia, COPD, exacerbation, ACS, PE, sepsis, asthma, ARDS, interstitial lung disease, trauma
Type 1 = hypoxicemic
49
imbalance between load on respiratory muscles + muscle pump capacity leading to PaCO2>45mmHG and pH<7.35 (lungs not functioning), acute, acute on chronic, chronic From obstructive, pulmonary edema, OHS, drug intoxication, neuromuscular disorders, chest wall disorders
Type 2 = hypercapnic
50
What are rough guidelines for acute respiratory failure diagnosis?
PO2<60 (SpO2 <91%) in a nonCOPD and (SPO2<88% in COPD) PCO2>50mmHG
51
What are diagnostic tools for acute respiratory failure?
Repeat vitals Continuous pulse ox ABG CXR EKG Troponin pro-BNP UDS Echo
52
What's first line for acute respiratory failure?
ABCs: airway, breathing, circulation Oxygenation - low flow, simple face mask, high flow, non-invasive positive airway pressure, intubation Goal: >92% for non-COPD 88-92% w/ COPD
53
Goal for oxygenation in ARF w/ non-COPD:
>92%
54
Goal for oxygenation in ARF w/ COPD
88-92%
55
What are these indications for: Respiratory muscle fatigue (current or impending) Hypoxia not corrected by nasal cannula, HFNC, or mask Pulmonary edema FIRST LINE FOR COPD in hypercapnic failure
NIPPV
56
When is NIPPV contraindicated?
CI IF: significant secretions, facial trauma, burns, high risk of aspiration, AMS, long-term need
57
What are these indications for: Hypercapnic encephalopathy (CO2 narcosis) Hypoxemia despite oxygen therapy Impaired airway protection Respiratory acidosis Refractory hypoxemia despite HFNC or biPAP Respiratory muscle exhaustion Apnea
intubation
58
What are these indications for: apnea Acute hypercapnia Severe hypoxemia Progressive patient fatigue
mechanical ventilation
59
When do you use ECMO in acute respiratory failure?
for cardiac failure or both cardiac/resp failures
60
ARDS requirements are
Acute hypoxemia <1 week Ratio<300 P/F on ABG Diffuse BL infiltrates Swan cath or echo - PCWP <18 (NO CARDIOGENIC PULM EDEMA)
61
hypoxemia is defined by
O2 <60 on ABG
62
Hypercapnia is defined by
CO2 >50 on ABG
63
Hypercapnia means
hypoventilation, commonly from a drug or obstructive disease process slowing ability to breathe
64
Hypoxemia means
likely something is blocking ventilation like pneumonia, aspiration