Ana de Luca
Pneumothorax!
Respiratory
Thoracentesis Accumulation of air in pleural space → dyspnea, uneven chest
expansion + chest pain, reduced tactile fremitus, hyperresonance,
and diminished breath sounds, all on the a ected side.
Lung anatomy!
Right lung has 3 lobes, left has 2 and lingula (homolog of right Tension pneumothorax → air enters but cant exit. The trapped
middle lobe). Instead of a middle lobe, left lung has a space air causes the tension. Diagnóstico clínico → se fez raio X ta
occupied by the heart. errado.
Atelectasis: alveolar collapse → multiple causes: May lead to increased intrathoracic pressure → mediastinal
- Obstructive: airway obstruction prevents new air from reaching displacement → kinking of IVC → lowered venous return→
distal airways, old air ir resorbed → foreign body, mucous plug, lowered cardiac output, obstructive shock (hypotension,
tumor. tachycardia), jugular venous distension.
- Compressive: external compression on lung decreases lung
volumes → pleural e usion. Needs immediate needle decompression and chest tube
- Contraction: cicatrization → scarring of lung parenchyma that placement. Obstructive shock and hypoxia are the ultimate
distorts alveoli (eg, sarcoidosis). result of a tension pneumothorax.
- Adhesive: due to lack of surfactant → NRDS in premature
babies.
Pleural e usions → excess accumulation of uid between
pleural layers → restricted lung expansion during inspiration → SINAIS CLÍNICOS DIAGNÓSTICO DE PNEUMOTÓRAX
treated with thoracentesis to remove/reduce uid. HIPERTENSIVO: ausência de murmúrio vesicular, som
hipertimpânico na percussão, paciente não ventila, padrões
Exudate → cloudy uid (cellular) → due to malignancy, de saturação baixa, taquicardico, hipotenso, congestão
in ammation/ infection → pneumonia, collagen vascular disease, jugular, traqueia desviada no raio X.
trauma. Drained because of the risk of infection.
Transudate → clear uid (hypocellular) → high hydrostatic Como diferencia ar de sangue na cavidade pleural no
pressure (eg, HF, Na+ retention) and/oroncotic pressure (eg, paciente chocado? Ar vai ter som hipertimpânico na percussão
nephrotic syndrome, cirrhosis). e no sangue vai ser maçico.
Lymphatic → chylothorax → thoracic duct injury from trauma or
malignancy. Milky-appearing uid; high triglycerides.
Pleura → serve para manter os pulmões “armados” na
ventilação, ou seja, abertos para as trocas gasosas. Isso porque
o líquido pleural, juntamente com uma pressão negativa da
cavidade pleural, mantém as pleuras parietal e visceral
estabilizadas e aderentes, evitando um colapso pulmonar.
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ff flfffl fl ff flfl
Pneumothorax!
Respiratory
Thoracentesis Accumulation of air in pleural space → dyspnea, uneven chest
expansion + chest pain, reduced tactile fremitus, hyperresonance,
and diminished breath sounds, all on the a ected side.
Lung anatomy!
Right lung has 3 lobes, left has 2 and lingula (homolog of right Tension pneumothorax → air enters but cant exit. The trapped
middle lobe). Instead of a middle lobe, left lung has a space air causes the tension. Diagnóstico clínico → se fez raio X ta
occupied by the heart. errado.
Atelectasis: alveolar collapse → multiple causes: May lead to increased intrathoracic pressure → mediastinal
- Obstructive: airway obstruction prevents new air from reaching displacement → kinking of IVC → lowered venous return→
distal airways, old air ir resorbed → foreign body, mucous plug, lowered cardiac output, obstructive shock (hypotension,
tumor. tachycardia), jugular venous distension.
- Compressive: external compression on lung decreases lung
volumes → pleural e usion. Needs immediate needle decompression and chest tube
- Contraction: cicatrization → scarring of lung parenchyma that placement. Obstructive shock and hypoxia are the ultimate
distorts alveoli (eg, sarcoidosis). result of a tension pneumothorax.
- Adhesive: due to lack of surfactant → NRDS in premature
babies.
Pleural e usions → excess accumulation of uid between
pleural layers → restricted lung expansion during inspiration → SINAIS CLÍNICOS DIAGNÓSTICO DE PNEUMOTÓRAX
treated with thoracentesis to remove/reduce uid. HIPERTENSIVO: ausência de murmúrio vesicular, som
hipertimpânico na percussão, paciente não ventila, padrões
Exudate → cloudy uid (cellular) → due to malignancy, de saturação baixa, taquicardico, hipotenso, congestão
in ammation/ infection → pneumonia, collagen vascular disease, jugular, traqueia desviada no raio X.
trauma. Drained because of the risk of infection.
Transudate → clear uid (hypocellular) → high hydrostatic Como diferencia ar de sangue na cavidade pleural no
pressure (eg, HF, Na+ retention) and/oroncotic pressure (eg, paciente chocado? Ar vai ter som hipertimpânico na percussão
nephrotic syndrome, cirrhosis). e no sangue vai ser maçico.
Lymphatic → chylothorax → thoracic duct injury from trauma or
malignancy. Milky-appearing uid; high triglycerides.
Pleura → serve para manter os pulmões “armados” na
ventilação, ou seja, abertos para as trocas gasosas. Isso porque
o líquido pleural, juntamente com uma pressão negativa da
cavidade pleural, mantém as pleuras parietal e visceral
estabilizadas e aderentes, evitando um colapso pulmonar.
fl
ff flfffl fl ff flfl
