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Pleural Disorders - Coggle Diagram

- - - - Closed
        
        Air leaks in into the pleural cavity through an opening in the chest
        
        Air can't leak out due to a valve mechanism
      - Open (sucking chest wound)
        
        Inspiration
        
        Air leaks in into the pleural cavity through an opening in the chest
        
        Expiration
        
        Air leaks out through the same opening
    - - Condition caused by medical examination or treatment
        
        Subclavian central venous catheter (CVC)
        
        Thoracentesis
        
        Pleural biopsy
        
        High positive end-expiratory pressure (PEEP) in mechanical ventilation
        
        CPR
    - - Blood trauma
        
        Motor vehicle accidents
        
        Massive fall
      - Bullet wounds
      - Stab wounds
    - - Primary
        
        Factors
        
        Thin
        
        Young
        
        Males
        
        Tall
        
        Smokers
        
        Marfan Syndrome
        
        Patient do not have lung diseases
      - Secondary
        
        Patient have underlying lung disease
        
        Obstructive lung disorders (COPD, Asthma, Cystic fibrosis)
        
        Destructive lesions (TB, Pneumocystis jiroveci pneumonia, Lung abscesses, CA lung: squamous cell CA)
    - - Can develop from any other pneumothorax
      - Mediastinum shift
      - Tracheal deviation
      - Compressed superior/inferior ven cava, right ventricle
      - Cannot wait for diagnostic imaging
      - Immediate treatment
        
        Chest tube
      - Very serious medical complications
  - - - Intrapleural P > Intrapulmonary P
        
        Lung cannot expand
        
        Air pushed lung to collapse
        
        Alveoli starts to collapse
        
        Less oxygen diffuse
        
        Hypoxemia
  - - - Decreased or absent breath sounds
    - - Hyperresonance
  - - - Respiratory alkalosis
  - - - Partially occlusive dressing, followed by chest tube
    - - Small
        
        Observation
      - Large
        
        Chest tube + ICU
    - - Chest tube with/without needle decompression (thoracostomy)
    - - Small
        
        Observation
      - Large
        
        Needle decompression/chest tube
    - - High flow oxygen
    - - Surgical pleurodesis (chemical/mechanical)
- - - - Supine/Semi-fowlers
    - - Pain/sedation
    - - UWSD
  - - - Equipment, sedation
    - - Emotional
    - - Vital signs, pain score, conscious level
  - - - CXR
    - - Color, amount
    - - Vital signs, chest tube, drainage, UWSD
    - - Deep breathing, incentive spirometer
- - - - Large hemothorax
      - Large pneumothorax
      - Pericardial effusion with or without tamponade
      - Fail chest
    - - Heart and lungs
      - Ribs, clavicle, trachea, bronchi, esophagus, and arteries including the aorta and veins
    - - Rib fractures
      - Small hemothorax
      - Small pneumothorax
      - Pulmonary contusion
      - Cardiac contusion
      - Chest wall contusion
  - - - Suspect of cardiac contusion
  - - - Pneumothorax
        
        Needle aspiration
      - Hemothorax
        
        Chest tube
      - ABCD
      - Surgery
        
        Drainage > 1000-1500mL, ongoing resuscitation (blood transfusion, persistent hypotension), ORIF ribs
      - Cardiac tamponade
        
        Pericardiocentesis
    - - HDU/ICU
        
        3 rib fractures, a flail segment, and any number of rib fractures with pulmonary contusions, hemopneumothorax, hypoxia, or pre existing pulmonary disease
      - Mild
        
        Monitoring and pain control
    - - PCA/nonnarcotic transdermal patches
  - - - Prone
  - - - Athletic injuries, falls, and assaults
    - - CPR
    - - Blunt, anterior chest-wall trauma, and deceleration injuries
    - - Osteoporosis, long-term steroid therapy, postmenopausal women, and elderly
    - - Steering wheel
    - - Blunt injury
        
        Fracture in the sternal manubrium
        
        Pain (moderate to severe)
        
        Limit deep inspiration
        
        Atelectasis
    - - Lateral CXR
      - CT chest
    - - Deep breathing exercise
      - Treat other conditions
        
        Fracture ribs, hemothorax, cardiac contusion, etc
      - Pain control
  - - - Most vulnerable
    - - Mobile -> difficult to break
    - - Hardest to break
    - - Traumatic
        
        Penetrating or blunt
      - Atraumatic
        
        Athletic injuries, fall, cancer metastasis, severe cough, child abuse
    - - Pain
      - Decreased ability to perform full inspiration
      - Chest wall
        
        Bruising + bony tenderness to palpitation or crepitus
    - - CXR
      - CT chest
    - - Incentive spirometer
      - Rib # nonunion, chest wall deformity/defect, refractory rib fracture pain causing respiratory failure, flail chest – surgery
      - Pain control
      - Hypoxia, tachypnea, or significant respiratory distress – further evaluation of pneumothorax, hemothorax, cardiac and pulmonary contusions
      - Lower rib segment injuries – assessment for kidney, liver, and spleen injury
    - - Flail chest
        
        3 rib fractures at two points on the involved ribs, creating a floating rib segment
    - - Paradoxical chest wall movement