Flashcards in Chest X-rays Deck (17)
How do you treat a pneumothorax?
Bilateral/haemodynamically unstable? Yes= chest drain
>50? smoking Hx/ evidence of underlying chest pathology on CXR or exam? Yes= secondary pneumothorax.
Primary Pneumothorax- >2cm and/or breathless = aspirate with needle. (success or No )= discharge and review in ODP in 2-4 weeks.
1) 1-2 cm No= admit + oxygen and observe 24hrs. Yes= needle decompression, if now under 1cm = sucess and admit
2) >2cm or breathless = chest drain
where to you measure the size of a pneumothorax
inter-pleural space at level of the hilum
How do you treat heart failure acutely?
Postition+ Positive pressure ventilation
What is CURB-65?
U- urea over 7
B- SBP <90 mmHg or DBP <60 mmHg
65- over 65
How does CURB-65 effect treatment?
1 = low risk manage in community
2= probable admission vs close ODP monitoring
3-5= admit treat as severe
How do you assess a CXR?
PA or AP. Rotation
Expansion= 7 anterior ribs
Exposure- Apcies to diaphragm
Penetration= 3 verterbral discs behind mediastinum
Trachae- central vs deviated
Lung Fields- clear, symetrical, extend to pleura?
Mediastinal contours (aortic knuckle)
hemidiaphragm- higher on the right?
costophrenic/ costocardiac angles?
How do you manage Heart Failure Chronically?
MDT: HF nurse
ACE inhibitor+ Beta-blocker
diuretics for fluid overload
What does COPD look like on a chest X-ray?
Hyperinflated lungs- hemidiaphragm below 7th rib anteriorly
Floating heart sign
How would you manage and acute exacerbation of COPD?
Oxygen 2L aiming for 88-92%
5mg neb salbutamol
500mcg neb ipratropium
100mg IV hydrocortisone
Abx as per guidline
How do you manage COPD chronically
Stop smoking, excercise, flu vaccine
1) Bronchodialator Therapy SABA
2) FEV1 >50 LABA eg salmeterol
FEV1<50 LABA + ICS
3) Oral theophylline
4) long term oxygen therapy if PO2 <7.3
What does a Left lower lobe collapse look like on CXR?
Tracheal Deviation to Left
Sail Sign- have a dense edge of the left lower lobe behind the mediastinum which has been squaished into a triangle.
Loss of left hemi-diaphragm
as LLL no longer has air in it it is the same density as the diaphragm and therefore blends into it
What causes lobe collapse?
Mucous plug eg post op atelectasis
How do you manage a lobular collapse?
Treat Cause (post surgical- physiotherapy, coughing, walking)
Consider CPAP if hypoxic on air
Abx if infective
Consider bronchoscopy to remove mucous plug.
What is Light's criteria?
determinate of an exudative vs transudative pleural effusion.
Exudate if one or more is present=
1) effusion protein/serum protein >5
2) effusion LDH/serum LDH >0.6
3) effusion LDH >2/3 the upper limit of normal serum LDH
Common Causes of Transudates?
common causes of exudates?