Pre-Lab

Question 1

What do you call air trapped in the pleural cavity creating a collapsed lung?

Answer 1

a pneumothorax

Question 2

When you have a right pneumothorax what kind of shift will you have?

Answer 2

a left shift of mediastinal structure

Question 3

If you have a pneumothora, what happens to your IVC?

Answer 3

it gets kinked

Question 4

If you have a left mediastinal shift due to a right pneumothorax what happens to the lung volume on the left lung?

Answer 4

you get reduced lung volume

Question 5

A pneumothorax is in between what two layers?

Answer 5

the parietal pleura and visceral pleura of the lung

Question 6

All together what happens when you have a right pneumothorax?

Answer 6

collapsed right lung, kinked IVC (reduced venous return), left shifted mediastinal structure, reduced left lung volume.

Question 7

What is a survival pneumothorax, a open or tension?

Answer 7

Open!

Question 8

When you have an open pneumothorax, why is it better than a tension pneumothorax?

Answer 8

An open pneumothorax allows for reduced mediastinal shift upon expiration and therefore increaesed lung volume upon expiration and increased venous return. A tension does not allow for this increased venous return

Question 9

What does this describe:
Air enters pleural cavity through open, sucking chest wound. Negative pleural pressure is lost, permittin collapse of ipsilateral lung and reducing venous return to heart. Mediastinum shifts, compressing opposite lung.

Answer 9

Open (sucking) pneumothorax during inspiration

Question 10

What does this describe:
as chest wall contracts and diaphragm rises, air is expelled from pleural cavity via wound. Mediastinum shifts to affected side and mediastinal flutter further impairs venous return by distortion of vena cave

Answer 10

Open (sucking) pneumothorax during expiration

Question 11

what is this:
patient often cyanotic and in severe respiratory distress or in shock. Immediate closure of sucking wound imperative, preferably by petrolatum gauze pad, but if not available, by palm or anything at hand.

Answer 11

pneumothorax

Question 12

What is this:
air enters pleural cavity through lung wound or ruptured bleb (or occasionally via penetrating chest wound) with valvelike opening. Ipsilateral lung collapses and mediastinum shifts to opposite side, compressing contralateral lung and impairing its ventilating capacity/

Answer 12

Tension pneumothorax during inspiration

Question 13

What is this:
intrapleural pressure rises, closing valvelike opening, thus preventing escape of pleural air. Pressure is thus progressively increased with each breath. Mediastinal and tracheal shifts are augmented, diaphragm is depressed, and venous return is impaired by increased pressure and vena caval distortion.

Answer 13

Tension pneumothorax during expiration

Question 14

Is a tension pneumothorax deadly?

Answer 14

yes

Question 15

What is this:
Air goes in and the lung is collapsed. There is still a piece of tissue left where the rupture is and it allows for air to enter but not to leave so you get a huge build up of air and a compression of lung along with left mediastinal shift that cannot be fixed via expiration due to the flap acting as a one way valve. So during expiration it gets even worse.

How do you fix it?

Answer 15

Tension pneumothorax

Fix this by converting tension into open pneumothorax via a tube being inserted into the pleural cavity.

Question 16

How can you determine you have a pneumothorax?

Answer 16

you have a shift in trachea showing a mediastinal shift, also insert a plunger and if it moves out you know air is pushing against plunger.
To fix this you shove a tube into the pleural cavity to remove air.

Question 17

(blank) is inserted for emergency relief of intrathoracic pressure. Finger cot flutter valve, heimlich valve, or underwater seal should be attached.

Answer 17

large-bore needle

Question 18

What are these sources for:

1: lung
2: intercostal vessels
3: internal thoracic (internal mammary) artery
4: thoracicoacromial artery
5: lateral thoracic artery
6: mediastinal great vessels
7: heart
8: abdominal structures (liver, spleen) via diaphragm

Answer 18

Hemothorax

Question 19

What are the worst places for a hemothorax to originate from? Best places?

Answer 19

the heart, SVC, or lung tissue

thoracicoacromial artery or lateral thoracic artery

Question 20

If you have a minimal hemothorax (up to 350 ml), what do you do?

Answer 20

you allow blood to resorb spontanteously with conservative management. Dont need a thoracentesis

Question 21

If you have a moderate hemothorax ( 350 to 1500 ml) what do you do?

Answer 21

Thoracentesis and tube drainage with underwater-seal drainage usually suffices

Question 22

If you have a massive hemothorax (over 1500 ml) what do you do?

Answer 22

insert 2 drainage tubes since one may clog. Early thoractomy may be necessary

Question 23

For a pneumothorax where do you want to insert the tube?

Answer 23

2nd or 3rd interspace at midclavicular line!!!

Question 24

For a hemothorax where do you want to insert the tube?

Answer 24

5th interspace at midaxillary line

Question 25

(blank) is an accumulation of a significant amount of fluid in the pleural cavity.

Answer 25

hydrothorax

Question 26

What may result from pleural effusions (escape of fluid into the pleural cavity)?

Answer 26

hydrothorax

Question 27

When inserting a needle to remove fluid build up in the pleural cavity, how do you do it?

Answer 27

at an angle upwards so that you dont puncture the diaphragm

Question 28

What is inflammation of the pleura?

Answer 28

pleuritis

Question 29

Rough surfaces of the pleurae produce a so-called (blank)

Answer 29

pleural friction rub

Question 30

The inflamed surfaces of the pleura may also cause the parietal and visceral layers of the pleura to adhere which is called (blank)

Answer 30

pleura adhesions

Question 31

What are primary malignant tumors arising from the visceral and parietal pleura. Mostly an occupationally related disorder of asbestos workers.

Answer 31

mesothelioma of pleura

Question 32

When doing a thoracentesis what are the 2 main things you must do?

Answer 32

go at an angle and use a lot of anesthesia

Question 33

Insertion of needle into pleural cavity

Answer 33

thoracentesis

Question 34

Which layer, the parietal or visceral layer has pain receptors?

Answer 34

the parietal

Question 35

What do you need when you do a thoracocentesis what kind of seal do you need?

Answer 35

an underwater-seal drainage

Question 36

``` When there is trauma to the thoracic wall are these simple or complicated: costovertebral dislocation (any level) Transverse rib fracture oblique rib fracture overriding rib fracture chondral fracture costochondral separation chondrosternal separation sternal fracture ```

Answer 36

simple

Question 37

When there is trauma to the thoracic wall are these simple or complicated: traumatization of pleura and of lung (pneumothorax, lung contusion, subcutaneous emphysema) multiple rub fractures (stove-in or flail chest) Tear of blood vessels (hemothorax) compound by missile or puncture wound Injury to heart or to great vessels

Answer 37

Complicated

Question 38

What is this: fracture of several adjacent ribs in two or more places. This may be complicated by lung contusion or laceration.

Answer 38

flail chest

Question 39

What is an indication of flail chest?

Answer 39

paradoxical movements during inspiration and expiration | i.e when you inspire your lung goes inward medially

Question 40

What is an embolus and what can it be?

Answer 40

``` something that occludes a vessel blood clot air fat amniotic fluid foreign body mass of bacteria ```

Question 41

``` Are these more common or less common sources of pulmonary embolism? external iliac vein femoral vein popiteal vein posterior tibial veins soleal plexus ```

Answer 41

Most common

Question 42

``` Are these more common or less common sources of pulmonary embolism? right side heart gonadal veins uterine vein pelvic venous plexus lateral circumflex vein great saphenous vein small saphenous vein ```

Answer 42

less common

Question 43

If there is a sudden onset of dyspnea, paleness, increase temp and tachycardia in a predisposed individual what can you suspect?

Answer 43

pulmonary embolism

Question 44

What does an unclear costophrenic recess show?

Answer 44

an embolism

Question 45

(blank) embolus completely occluding pulmonary arteries.

Answer 45

saddle embolus

Question 46

What is a tumor that arises from the bronchial epithelium, tumor typically located near hilum projecting into bronchi.

Answer 46

bronchogenic carcinoma

Question 47

What is the bifurcation point of the trachea into the two main bronchi?

Answer 47

carietal region

Question 48

What may be designated as thoracic inlet tumor. The tumor (often a bronchogenic carcinoma) grows beyond the apex and encroaches upon important anatomical structures in the neck. Considered the WORST tumor. It grows real fast.

Answer 48

pancoast's syndrome