week 9 Flashcards by Ivy Jones

classifications of pneumothorax based off primary, secondary and iatrogenic

primary = spontaneous
secondary = underlying disease
iatrogenic = due to medical procedure

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symptoms of spontaneous pneumothorax

dyspnoea acute
pleuritic chest pain

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tension pneumothorax definition 4 main steps

when a one way valve devlops whereby every breath causes increased trap air

leading to increased intraplueral pressure

mediastinal shift
collapses of vessels

resulting in cardiopulmonary comprimise

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risk factors for spontaneous and secondary pneumothorax (age groups, social and family)

PSP: young, skiny, male
SSP: old, underlying lung disease
smoking incl vape and weed
FHx

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findings on pneumothorax 4 (2 are key)

trachea can be deviated to opposite side
reduced chest expansion on collapsed side
hyperesonance
reduced/absent breath sounds

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investigations for suspected pneumothorax 5
General rule out others

troponin
inflammatory markers
ECG
CXR
Ct

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what is the key diagnostic investigation for pneumothorax

CXR

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PSP management (haemodynamically stable and haemodynamically unstable)

stable = observation
unstable = tube thorocastomy+drainage

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SSP management

tube thorocastomy+drainage

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secondary measure if pneumothorax recurrence

pleurodesis

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pleurodesis types 2

can be chemical or mechanical

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pleurodesis mechanism

triggers inflammation

leads to fibrosis

fills pleural space

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what is required for pleurdesis to work? When does it not work?

symphis of visceral and parietal pleura

in non expansive lung there is no symphis

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common chemical agent used in pleurodesis

TALC

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pleural effusion

air/fluid in pleural space

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transudative effusion vs exudative effusion

transudative due to abnomral hydrostatic forces

exudative due to increased capillary permeability

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most common causes of transudative pleural effusion 3 (think major body organs)

HF
cirrohosis
PE

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most common cause of exudate pleural effusion 3

malignancy
pneumonia
TB

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different types of infective pleural effusions 3

para pneumonic
complex parapneumonic
empyema thoracis

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parapneumonic effusion 3

no pus
negative cultures
normal pH and glucose

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complex parapneumonic

no pus
low pH
potentially culture positive

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empyema thoracis

pus
potentially positive culture

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mech for development of malignant pleural effusion 2

primary malignancy from mesothelioma
metatstatic pleural spread

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most common causes of malignant pleural effusion

breast cancer
lymphoma
mesothelioma

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clinical findings in someone with pleural effusion 6

SOB cough clubbing stony dull percusion redcued/absent breath sounds reduced chest expansion ipsilaterally

key diagnostic investigations in pleural effusion 2

thoracic ultrasound CXR

other tests used when investigating an aspirate of pleural effusion 4

pH glucose = if low maligancy cell count cytology

lights criteria in pleural effusion (when used and criteria)

used to determine exudative pleural effusion if one or more of the criteria is met the criteria are if serum protein, serum LDH or pleural fluid LDH is highly elevated

VATS - video assisted thoracoscopic surgery vs thoracotomy

VATS: less invasive, less complex, reduced post op pain Thoracotomy: greater access, more invasive, greater visibility

thoracentesis vs tube thoracostomy

throacentesis is a needle aspiration tube thoracostomy is tube inserted to drain

primary procedure in management of malignant pleural effusion

thoracentesis

symptoms of PE 4

SOB pleuritic pain haemoptysis dizziness

clinical signs of PE

tachypnoea tachycardia hypotension elevated JVP

virchow's triad

blood stasis hypercoagulability vessel wall injury causes development of venous thrombus event

definition of PE

obstruction of pulmonary artery by thrombus which is either provoked or unprovoked

classifications of PE 3

haemodynamically stable submassive PE massive PE

submassive PE characteristics 2

systolic>90 (no hypotension) RV dysfunction

massive PE characteristics 3

sustained hypotension <90 pulselessness HR<40

provoking factors for a PE (think what causes clotting) 5

recent immobilisation smoking birth control obesity cancer

well's score and what this indicates for D-dier

predicts liklihood of a venous thrombus event if low do D-dimer test if high proceed to management

ECG signs in PE (all signs of right sided dysfunction)

tachycardia RBBB RAD

key diagnostic tool in PE

CTPA - CT pulmonary angiography

what is CTPA

CT pulmonary angiography which visualises pulmonary vasculature

investigations for PE

ECG, ECHO, CTPA, D-Dimer if indicative wells score

management of haemodynamically stable PE

oxygen support anticoagulation

management of haemodynamically unstable PE

ICU review thrombolysis considered

drug of choice in anticoagulation of PE

Apixaban

characteristics of pulmonary circulation

low pressure low resistance vessels have thinner walls pulmonary capillaries larger than systemic capillaries

symptoms of pulmonary hypertension 5

SOB chest pain syncope exercise intolerance fatigue

clinical signs of pulmonary hypertension

raised JVP systolic murmur right sided HF

what heart side heart failure is pulmonary hypertension associated with

Left sided

classifications of pulmonary hypertension 5 (the groups)

group 1 = idiopathic group 2 = associated w heart disease group 3 = associated w lung disease group 4 = associated w PA obstruction group 5 = multiple systems

key cause of pulmonary hypertension

vascular remodelling due to endoethial proliferation or fibrosis

gold standard investigation in pulmonary hypertension

cardiac catheritization

definition of pulmonary hypertension

patients with a mean pulmonary artery pressure>20mmHg

3 pathways of pulmonary hypertension management

endothelin pathway nitric oxide pathway protocyclin pathway

endothelin pathway in pulmonary hypertension

block endothelin which causes vasoconstriction use endothelin receptor anatgonsist

nitric oxide pathway

use medication like nitric oxide to create vasodilatory effect

prostocyclin pathway

prostocyclin analogues which like prostocylcin vasodilate, stop platelets and smooth muscle cell proliferation

prostocylins function 3

vasodilatory stop platelet agglutination stop smooth muscle cell proliferation

what is the best maneouvre film to see a pneumothorax

expiratory film

what key radiological feature is evident in pulmonary oedema (hard)

air bronchograms

bochdalek hernia 3 characteristics (whether congenital or acquired and position of presentation)

congenital bilateral at the back

morgagni hernia 2 characteristics (whether congenital or acquired and position of presentation)

congenital middle

hiatus hernia

abdominal content through oesophageal hiatus into upper chest

high risk groups for anaemia

children pregnant women women

most common cause of anaemia

iron deficiency

social determinants of anaemia 3

gender = higher in women lower social economic countries = likely refelects poor diet geography = poor diet+greater infection

when do you do a d-dimer for pe

when the wells criteria score is less than 4 aka when there is low indication of PE

what is another diagnostic technique you can do for PE and when is this commonly done 4

V/Q scan do when contraidnications to cTPA including: - allergy to contrast - kidney impairement - pregnant - children

common ecg findings on a pe and theoretical findings

sinus tachycardia, often nothing else theoretical finding: is S1Q3T3

in tension pneumothorax does the trachea deviate away from the area of collapse or towards

away

in normal lung collapse can trachea deviate towards or away from collapsed lung

towards