Patient is a 61-year-old white male admitted through the ER with on December 10 with recurrent right pneumothoraxes. Patient is known to have COPD with emphysema and has multiple admissions for problems concerning this. At the time of initial evaluation, a small caliber chest tube was inserted in the anterior axillary line, which improved the patient’s respiratory distress but did not completely resolve the pneumothorax. I was called to the ICU to place a second small caliber chest tube in the posterior axillary line below this. This further improved the patient’s pulmonary status with his saturation improving from 76& to 89%. Since admission he has felt better but complained of pain at the chest tube insertion site. He has continued to leak out through the pleur-evac under water seal, and beginning yesterday he developed subcutaneous emphysema, which has gotten progressively worse. Earlier today he began having increased respiratory difficulty again, with his saturation dropping to approximately 80 % despite oxygen per nasal cannula. Chest x-ray today showed a worsening of the right lower lobe loculated pneumothorax, and on examination today he is not only leaking air through the pleur-evac system but also around the two chest tubes.…
PROCEDURE: With the usual Betadine scrub to the area marked by ultrasound, the area was anesthetized with approximately 15 cc of 1% lidocaine, and then a small-caliber #21-gauge needle was inserted into the space. Fluid was removed for appropriate bacteriological, hematological, and chemical analyses.Once this was accomplished, then a larger tube using a Cope pleural biopsy needle was inserted into the space, and four quadrants were biopsied and sent for appropriate pathological specimens. Once that was accomplished, then using a small-caliber temporary chest tube from the Cope, as well as the pneumothorax set, the space was entered, and 1.5 liters of bloody fluid was removed. A small bandage was attached afterward. There was no pain involved, and the chest x-ray will be taken afterward to assure ourselves that we had a reasonable effect without any ill consequences.…
All of the following can block a bronchus and cause incomplete expansion of a lung except…
It decreases surface tension in the alveoli making it easier for the alveoli to increase surface area for gas exchange.…
Air enters through nostrils which contain coarse hairs. The pharynx is shared between the digestive and respiratory system and extends between the nostrils and the larynx. The larynx joins the pharynx to the trachea; it consists of cartilages and is also known as the voice box. The trachea divides to form the primary bronchi, the left and right bronchi which the bronchi are two tubes that carry air into the lungs and they .break down into smaller branches which are called bronchioles. At the end of these are air sacs called alveoli which absorb oxygen from the air. The diaphragm is a muscle which is directly below the lungs, during inhalation the diaphragm contracts to allow the chest cavity to expand as the lungs fill with air.…
Pneumothorax is presence of air in the pleural cavity. It prevents your lung from expanding properly when you try to breathe in, causing shortness of breath and chest pain. It is also called as Collapse lung. A primary pneumothorax occurs without an apparent cause and in the absence of significant lung disease, while a secondary pneumothorax occurs in the presence of existing lung pathology. Tension pneumothorax develops occasionally and is a medical emergency. Unless reversed by effective treatment, these sequelae can progress and cause death. Catamenial pneumothorax is a rare condition where women experience pneumothorax at the onset of menstrual period.…
Each student selects a different Case Study and notifies the instructor via email on your…
Abnormal permanent enlargement of lung spaces distal to terminal bronchioles accompanied by destruction of walls without obvious fibrosis. This leads to decline in alveolar surface area available for gas exchange. Loss of alveoli leads to airflow limitation in 2 ways: first, loss of the alvoelar walls results in a decrease in elastic recoil (leads to airflow limitation). Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits airflow.…
Breathing in is an active process, which means it uses energy, and the process is as follows: the external intercostal muscles contract, whilst the internal muscles relax; the ribs are pulled upwards and outwards which increases the volume of the chest (thoracic cavity) and the muscles of the diaphragm contract which causes it to flatten, (this also increases the volume of the thoracic cavity). The volume increase in the thorax results in reduced pressure in the lungs, so atmospheric pressure is now greater than pulmonary pressure; therefore air is forced into the lungs.…
12 The diagnosis of an open pneumothorax is by rapid bilateral chest auscultation a. TRUE…
The expandation of your lungs causes the air to be breathed in through your nose or mouth. The air goes down your windpipe and into lungs. Through your bronchial tubes it helps the air to reach and enter the alveoli or air sacs.…
Ineffective Airway Clearance r/t Pleuritic pain as evidenced by Ms. Saxon reporting that her chest is sore after coughing/ sounds heard during auscultation.…
In diagnostic radiology we technicians are responsible to take the PA chest x-ray of the patient in order for the radiologist to properly diagnosis the image. The image should clearly show the lung field, so that means neither the top or bottom should be cut off. If positive for mesothelioma, it’s usually because of certain key findings in the image. For instance images showcasing pneumothorax, pleural effusion, and pleural thickening is a sign mesothelioma. The best way to see mesothelioma findings on a radiograph is plaque-like, concentric, unilateral, or nodular pleural thickening. The most common is pleural effusions and they may obscure the existence of the underlying pleural thickening (Gerald de Lacey. 2008, May 14). When a pneumothorax is small, this air-fluid level can be the only key to the diagnosis of a pneumothorax, also often skinfolds on a patient can be misdiagnosed as pneumothorax. Also, recognition of a pneumothorax depends on the volume of air in the pleural space and the position of the body. On a supine radiograph a pneumothorax can be subtle and approximately 30% of pneumothoraxes are undetected (Truong, M. T., 2004). The now tumor that is forming usually extends into the fissures, then they become irregular and thickened in contour. The tumor can rigidly restrict the lung, causing compression of diaphragm elevation, lung parenchyma, intercostal space narrowing, and mediastinal shift…
* Chest pain or discomfort that worsens when you take a deep breath or when you cough…
The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with a biopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research about screening tests for the early detection of mesothelioma is ongoing.…