how much blood can be in the pleural space before it shows on CXR?
200-300ml
signs/sxs of penetrating chest traum
hemoptysis, pneumothorax, subcutaneous emphysema, mediastinal emphysema, dullness/absent breath sound
beck’s triad (tamponade)
JVD, hypotension, and muffled heart sounds
workup for penetrating chest trauma
CT, Echo, angio (if bleeding out but not sure form where)
what is the LD50 for falls
4 stories (stated in class, slide 8)
most common side for traumatic diaphragmatic hernia
left side
signs of traumatic diaphragmatic hernia
resp. distress, decreased breath sounds, BS in the chest, abd pain, paradoxical respiration
tx for traumatic diaph. hernia
trans-abdominal repair (come from below and pull intestines down)
how many ribs involved for flail chest
3+
tx for pt with 1-2 non-displaced rib fractures with no signs/sxs of more significant injury
treat for pain (NSAIDs +/- narcotics) and d/c
complications of rib fractures
atelectasis and PNA
if pt does not improved from rib fracture, when should follow up xray be taken
4-6 week
how often should you get a chest xray when pt has a hemothorax
q8h
xray finding for pulmonary contusion
irregular, nonlobular opacification of the pulmonary parenchyma
complications of pulm. contusion
resp. distress, hemoptysis, PNA
tx of pulmo. contusion
pain control and pulm. toilet
most common cause of sternal fractures
steering wheel impact
level of the carina
T5
level of esophageal hiatus
T9-10
what is achalasia
loss of peristalsis in the distal esophagus and a failure of lower esophageal sphincter relaxation with swallowing
most common epidemiology of achalasia
primary dysmotility
sxs of achalasia
dysphasia with solids, followed by dysphagia to liquids, regurg after meals, heartburn
dx of achalasia (test of choice)
esophageal manometry
finding on barium esophagram c/w achalasia
bird’s beak
tx for achalasia
nitrate or Ca channel blockers to reduce LES tone
-botulism, pneumatic dilatation
most common cause of esophageal perf.
trauma (iatrogenic)
location of instrument esophageal perfs
cervical esophagus
location of spontaneous esophageal perfs
distal esophagus
hamman’s sign
audibly crunchy rasping sound synchronous with the heart beat
dx of esophageal perf
CXR-signs of perf
esophagogram- with gastrograffin
tx of esophageal perf
NPO, IVF, abx, NGT
-observe vs surgery
(large perf +/- signs of mediastinitis, sepsis, shock require emergent surgery)
boerhaave syndrome is a/w what?
violent vomiting an wretching
most common location of perf with boerhaave syndrome
left posterolateral distal esophagus
tx of boerhaave
ABC, abx, surgery!
most common cause of hemoptysis
bronchitis
bacterial accounts for 70%
management of hemoptysis
ABCs, bronchoscopy->angiography (dx and tx)
definition of spontaneous pneumothorax
collection of air within the pleural space with collapse of the affected lung
who is most likely to have spontaneous pnuemothorax
teens, young adults, tall thin men
sxs of spont. pneumo.
sudden onset of pleuritic chest pain and dyspnea
PE of spont. pneumo.
tachycardia, decreased breath sounds, hyperresonance
tx of spont. penumo.
30%=chest tube
when should pt with spont. pneumo undergo video assisted thoroscopy (VATs)
recurrent pneumothorax, failure to resolve, persistent air leak
definition of tension pneumothorax
pneumothorax with mediastinal shift which can impair venous return and cause HYPOtension and cardiac arrest
PE of tension pneumothorax
hyperresonance, decreased breath sounds, tracheal shift, HYPOtension or PEA
placement of angiocatheter to treat tension penumothorax
2nd ICS MCL
