Managing pneumothorax
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This document discusses the management of pneumothorax. Key factors in treatment include whether the pneumothorax is spontaneous or traumatic, primary or secondary, the patient's age and symptoms, and the size of the pneumothorax. Small pneumothoraces may be treated with oxygen or simple aspiration while larger ones often require a chest drain. Follow up is important to ensure complete resolution. Recurrent or bilateral pneumothoraces may require early specialist involvement. Treatment options range from observation to procedures like thoracotomy or pleurodesis.
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Pneumothorax
Pneumothorax is the presence of air in the pleural space and can be spontaneous, due to trauma, or iatrogenic. It is classified as primary spontaneous which occurs without lung disease usually in young males, secondary spontaneous which occurs with underlying lung pathology, or traumatic. Types include closed which seals off, open with a bronchopleural fistula, and tension which increases pressure. Clinical features include chest pain and shortness of breath. Diagnosis is made with chest x-ray showing increased radiolucency. Small primary pneumothoraces may resolve on their own while secondary pneumothoraces and those with symptoms require tube thoracostomy drainage. Recurrent cases require pleurodesis or surgery.
A very short description on Chest injury
Chest trauma can cause serious injury and is a common cause of disability and mortality after head and spinal cord injuries. Mechanisms of injury include blunt trauma, crush injuries, penetrating wounds, burns, and inhalation of foreign objects. Specific injuries include rib fractures, lung injuries, pneumothoraces, hemothoraces, aortic ruptures, and diaphragm injuries. Diagnosis involves history, physical exam noting diminished breath sounds and tracheal deviation, chest X-ray to detect fractures and lung abnormalities, and CT scan which aids in precise diagnosis of injuries.
Pneumothorax
This document discusses pneumothorax, which is an abnormal collection of air in the pleural space. A pneumothorax can occur when the negative pressure that normally exists in the pleural space is lost, allowing the lung to collapse. Symptoms include chest pain and dyspnea. Different types of pneumothorax are discussed, as well as causes, diagnostic tools, and treatment approaches which may include observation, needle aspiration, chest tube placement, or surgery depending on the size and severity in each case. Recurrent pneumothorax may warrant surgical pleurectomy or chemical pleurodesis to prevent future occurrences.
Tension pneumothorax - Interesting Emergency Case presentation
A patient presented to the emergency department with sudden onset shortness of breath, cough, and chest pain. On examination, the patient's breathing sounds were decreased bilaterally with wheezing. Tests showed ischemic changes on ECG and type 1 respiratory failure on ABG. Chest X-ray revealed a secondary spontaneous pneumothorax. The patient was treated with intercostal drainage and discharged after two days with medications.
(Pneumothorax
Pneumothorax is the presence of air or gas in the pleural space between the lung and chest wall. It occurs when there is a communication between an alveolus or air space and the pleural space, allowing air to enter the pleural space. Pneumothoraces are classified as spontaneous (primary or secondary), traumatic, or iatrogenic. Treatment depends on the type and severity but may include observation, oxygen therapy, needle aspiration, chest tube drainage, chemical pleurodesis, or surgery. Complications can include infection, bleeding, or mediastinal and subcutaneous emphysema.
Hemoptysis
This document discusses life threatening hemoptysis (LTH), including causes, evaluation, management, and treatment options. Common causes of LTH include infections like tuberculosis, tumors, cardiovascular issues, and trauma. Evaluation involves clinical history, physical exam, imaging like chest X-ray, and bronchoscopy. Management includes stabilizing the patient, identifying the bleeding source, and treating the underlying condition medically or surgically if stable and feasible. Bronchial artery embolization may help control bleeding but has risks. Drugs may help in some specific cases.
10.Pneumothorax
- The document discusses pneumothorax, describing its classification, pathogenesis, clinical presentation, diagnosis, and treatment options.
- Key points include that tension pneumothorax can cause rapid deterioration and requires immediate treatment, while spontaneous pneumothorax is classified as primary or secondary depending on underlying lung health.
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Pneomothorax & hemothorax by Farshid Mokhberi
This document discusses pneumothorax and hemothorax. It defines pneumothorax as a collection of air in the pleural space, which can be spontaneous or traumatic. Tension pneumothorax is a life-threatening condition where air builds up pressure in the pleural space. Hemothorax is defined as a collection of blood in the pleural space. The document covers causes, pathogenesis, clinical presentations, and treatment approaches for pneumothorax and hemothorax.
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Pneumothorax
Pneumothorax is the presence of air in the pleural space and can be spontaneous, due to trauma, or iatrogenic. It is classified as primary spontaneous which occurs without lung disease usually in young males, secondary spontaneous which occurs with underlying lung pathology, or traumatic. Types include closed which seals off, open with a bronchopleural fistula, and tension which increases pressure. Clinical features include chest pain and shortness of breath. Diagnosis is made with chest x-ray showing increased radiolucency. Small primary pneumothoraces may resolve on their own while secondary pneumothoraces and those with symptoms require tube thoracostomy drainage. Recurrent cases require pleurodesis or surgery.
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Pneumothorax
This document discusses pneumothorax, which is an abnormal collection of air in the pleural space. A pneumothorax can occur when the negative pressure that normally exists in the pleural space is lost, allowing the lung to collapse. Symptoms include chest pain and dyspnea. Different types of pneumothorax are discussed, as well as causes, diagnostic tools, and treatment approaches which may include observation, needle aspiration, chest tube placement, or surgery depending on the size and severity in each case. Recurrent pneumothorax may warrant surgical pleurectomy or chemical pleurodesis to prevent future occurrences.
Tension pneumothorax - Interesting Emergency Case presentation
A patient presented to the emergency department with sudden onset shortness of breath, cough, and chest pain. On examination, the patient's breathing sounds were decreased bilaterally with wheezing. Tests showed ischemic changes on ECG and type 1 respiratory failure on ABG. Chest X-ray revealed a secondary spontaneous pneumothorax. The patient was treated with intercostal drainage and discharged after two days with medications.
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Pneumothorax is the presence of air or gas in the pleural space between the lung and chest wall. It occurs when there is a communication between an alveolus or air space and the pleural space, allowing air to enter the pleural space. Pneumothoraces are classified as spontaneous (primary or secondary), traumatic, or iatrogenic. Treatment depends on the type and severity but may include observation, oxygen therapy, needle aspiration, chest tube drainage, chemical pleurodesis, or surgery. Complications can include infection, bleeding, or mediastinal and subcutaneous emphysema.
Hemoptysis
This document discusses life threatening hemoptysis (LTH), including causes, evaluation, management, and treatment options. Common causes of LTH include infections like tuberculosis, tumors, cardiovascular issues, and trauma. Evaluation involves clinical history, physical exam, imaging like chest X-ray, and bronchoscopy. Management includes stabilizing the patient, identifying the bleeding source, and treating the underlying condition medically or surgically if stable and feasible. Bronchial artery embolization may help control bleeding but has risks. Drugs may help in some specific cases.
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- The document discusses pneumothorax, describing its classification, pathogenesis, clinical presentation, diagnosis, and treatment options.
- Key points include that tension pneumothorax can cause rapid deterioration and requires immediate treatment, while spontaneous pneumothorax is classified as primary or secondary depending on underlying lung health.
- Treatment involves observation for small primary pneumothoraces or procedures like aspiration, chest tube placement, or surgery depending on the size and symptoms.
Pneomothorax & hemothorax by Farshid Mokhberi
This document discusses pneumothorax and hemothorax. It defines pneumothorax as a collection of air in the pleural space, which can be spontaneous or traumatic. Tension pneumothorax is a life-threatening condition where air builds up pressure in the pleural space. Hemothorax is defined as a collection of blood in the pleural space. The document covers causes, pathogenesis, clinical presentations, and treatment approaches for pneumothorax and hemothorax.
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1. Pneumothorax is the presence of air in the pleural space causing lung collapse, and pneumomediastinum is the presence of air in the mediastinum.
2. Pneumothorax can be spontaneous, traumatic, or iatrogenic and is classified as primary or secondary depending on underlying lung conditions. Tension pneumothorax is a life-threatening form caused by trapped air that displaces mediastinal structures.
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Case presentation
A 5-day-old infant presented with shortness of breath, grunting, and poor feeding. Examination revealed reduced chest movements and diminished breath sounds on the left side. Chest X-ray showed pneumothorax. Pneumothorax is the presence of air in the pleural space, causing partial or complete lung collapse. It can be open, closed, or valvular. Causes include spontaneous (primary or secondary to lung disease) or traumatic (iatrogenic or non-iatrogenic) origins. Treatment options range from observation of small pneumothoraces to chest tube insertion or pleurodesis surgery for larger or recurrent cases.
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Bacterial pneumonia can result in parapneumonic effusions or empyema in the pleural space in about 40% of hospitalized cases. Empyema is defined as pus in the pleural space. Effusions are classified into exudative, fibropurulent, and organized stages. Common bacteria include Staphylococcus aureus, Streptococcus pneumoniae, and various gram-negative rods. Diagnosis involves chest imaging, microbiology of pleural fluid, and biochemistry of the fluid. Treatment involves antibiotics, tube thoracostomy, possible intrapleural fibrinolytics or antibiotics, and potentially more invasive procedures like thoracoscopy or thoracotomy if the effusion becomes complicated or organized
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This document provides an overview of pneumothorax, including its definition, classification, mechanisms, clinical presentation, diagnosis, and management. Pneumothorax is defined as the presence of air in the pleural space, and can be spontaneous, traumatic, or iatrogenic. It presents with symptoms like dyspnea and chest pain. Diagnosis is typically made through chest x-ray or CT scan. Management depends on the type and severity, and may include oxygen therapy, needle aspiration, chest tube drainage, or surgery like pleurodesis for recurrent cases.
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This document discusses pneumothorax, including its history, classification, signs and symptoms, diagnosis using imaging modalities like chest x-rays and CT scans, and various treatment options. Pneumothorax is the accumulation of air in the pleural space, usually caused by a tear or rupture in the lung tissue. Treatment depends on factors like the size and severity of the pneumothorax, its cause, and whether it is a first occurrence or recurrent. Options include observation, aspiration of air, insertion of a chest tube to drain air, chemical pleurodesis to fuse the lungs to the chest wall to prevent recurrence, and surgery in more severe or complicated cases.
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Pulmonary contusion is injury to the lung parenchyma caused by blunt chest trauma, resulting in edema and bleeding into the alveolar spaces. It is commonly caused by motor vehicle accidents. Clinically, patients may experience respiratory distress, coughing blood, and decreased breath sounds. Chest x-rays often under-estimate the injury, while CT scans can detect contusions immediately and assess severity. Treatment involves supportive care, oxygen supplementation, ventilation if needed, and prevention of complications like ARDS and pneumonia. Most contusions resolve within a week but can occasionally lead to long-term lung issues.
Open pneumothorax
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junctional zones of torso
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pneumothorax
Pneumothorax is the accumulation of air in the pleural space between the lung and chest wall. It can be caused by trauma, medical procedures, or spontaneously from conditions like bleb rupture. On chest x-ray, it appears as a visceral pleural edge without lung markings peripheral to it, indicating lung collapse. Tension pneumothorax is a medical emergency where pressure within the pleural space exceeds atmospheric pressure. Ultrasound can detect the absence of lung sliding and B-lines in pneumothorax. The size of pneumothorax influences management.
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Bronchiectasis final
Bronchiectasis is a chronic lung condition characterized by abnormal dilatation of the bronchi. It occurs due to destruction of the elastic and muscular components of the bronchial wall from repeated pulmonary infections. Common causes include cystic fibrosis, pneumonia, tuberculosis, and allergic bronchopulmonary aspergillosis. Symptoms include chronic cough with purulent sputum, pneumonia, hemoptysis, and poor health. Diagnosis involves sputum culture, chest x-ray, and high-resolution CT scan of the chest. Management includes chest physiotherapy, antibiotics, and sometimes surgery for uncontrolled infections or hemorrhage. Complications can include recurrent lung infections, abscesses, and respiratory failure.
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- Common injuries like pneumothorax, hemothorax, flail chest and their signs and symptoms.
- Assessment involves clinical exam, chest x-ray and ultrasound to detect injuries. Chest tube insertion can be both therapeutic and diagnostic.
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Empyema- Pus in Pleura
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This document discusses the management of spontaneous pneumothorax according to British Thoracic Society guidelines. It covers topics such as the use of chest tubes and suction, management of bronchopleural fistulas, indications for surgical consultation, post-treatment advice, and tension pneumothorax. Management involves chest tube drainage and observation for most cases, while refractory air leaks, bilateral pneumothorax, or high-risk professions may require surgical intervention or advice.
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1. Pneumothorax is the presence of air in the pleural space causing lung collapse, and pneumomediastinum is the presence of air in the mediastinum.
2. Pneumothorax can be spontaneous, traumatic, or iatrogenic and is classified as primary or secondary depending on underlying lung conditions. Tension pneumothorax is a life-threatening form caused by trapped air that displaces mediastinal structures.
3. Chest x-ray is used to diagnose pneumothorax by identifying the visceral pleural line and lung collapse. Features of tension pneumothorax on x-ray include mediastinal shift and tracheal deviation. Pneum
Case presentation
A 5-day-old infant presented with shortness of breath, grunting, and poor feeding. Examination revealed reduced chest movements and diminished breath sounds on the left side. Chest X-ray showed pneumothorax. Pneumothorax is the presence of air in the pleural space, causing partial or complete lung collapse. It can be open, closed, or valvular. Causes include spontaneous (primary or secondary to lung disease) or traumatic (iatrogenic or non-iatrogenic) origins. Treatment options range from observation of small pneumothoraces to chest tube insertion or pleurodesis surgery for larger or recurrent cases.
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Empyema presentation
This document provides information on empyema, including its definition, etiology, stages, symptoms, investigations, and management. Empyema is defined as infection of the pleural space resulting in pus accumulation. It is usually caused by bacteria spreading from a pneumonia or other infection. It progresses through exudative, fibrinopurulent, and organizing stages. Symptoms include fever, cough, chest pain, and shortness of breath. Diagnosis involves imaging like chest X-ray or CT scan and thoracentesis. Management includes antibiotics, chest tube drainage, fibrinolytics, VATS, and sometimes open drainage or decortication surgery. The goal is to treat infection, drain pus, and re-expand
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This document summarizes various types of thoracic trauma, including mechanisms of injury, anatomical injuries, pathophysiology, assessment findings, and management strategies. Some key injuries discussed include rib fractures, flail chest, pneumothorax, hemothorax, pulmonary contusion, myocardial contusion, pericardial tamponade, aortic dissection/rupture, and traumatic asphyxia.
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This document discusses esophageal injury, including its anatomy, causes, symptoms, diagnosis and management. The esophagus extends from the pharynx to the stomach. Injuries are often caused by medical procedures but can also result from trauma or spontaneous rupture. Symptoms vary depending on the location but may include chest pain, vomiting and subcutaneous emphysema. Diagnosis involves imaging and endoscopy. Treatment depends on factors like timing and location but typically involves antibiotics, nil by mouth, drainage and sometimes stents or surgery to repair the injury. Outcomes are best when treatment begins quickly but morbidity and mortality remain high if sepsis develops.
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This document discusses pneumothorax, including its history, classification, signs and symptoms, diagnosis using imaging modalities like chest x-rays and CT scans, and various treatment options. Pneumothorax is the accumulation of air in the pleural space, usually caused by a tear or rupture in the lung tissue. Treatment depends on factors like the size and severity of the pneumothorax, its cause, and whether it is a first occurrence or recurrent. Options include observation, aspiration of air, insertion of a chest tube to drain air, chemical pleurodesis to fuse the lungs to the chest wall to prevent recurrence, and surgery in more severe or complicated cases.
Pulmonary contusion
Pulmonary contusion is injury to the lung parenchyma caused by blunt chest trauma, resulting in edema and bleeding into the alveolar spaces. It is commonly caused by motor vehicle accidents. Clinically, patients may experience respiratory distress, coughing blood, and decreased breath sounds. Chest x-rays often under-estimate the injury, while CT scans can detect contusions immediately and assess severity. Treatment involves supportive care, oxygen supplementation, ventilation if needed, and prevention of complications like ARDS and pneumonia. Most contusions resolve within a week but can occasionally lead to long-term lung issues.
Open pneumothorax
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check out my next ppts for further more about torso trauma.
contents are in following order...
introduction
mechanism of injury
junctional zones of torso
tension pneumothorax
cardiac temponade
massive hemothorax
etc.
check out all slides
pneumothorax
Pneumothorax is the accumulation of air in the pleural space between the lung and chest wall. It can be caused by trauma, medical procedures, or spontaneously from conditions like bleb rupture. On chest x-ray, it appears as a visceral pleural edge without lung markings peripheral to it, indicating lung collapse. Tension pneumothorax is a medical emergency where pressure within the pleural space exceeds atmospheric pressure. Ultrasound can detect the absence of lung sliding and B-lines in pneumothorax. The size of pneumothorax influences management.
Chest Trauma
This document outlines the anatomy of the chest and describes various types of chest trauma, including blunt and penetrating injuries. It discusses the initial assessment and management of life-threatening injuries like tension pneumothorax, massive hemothorax, and cardiac tamponade. The document also covers procedures like needle decompression, tube thoracostomy, and emergency department thoracotomy that may be used to treat severe chest trauma. Overall, the document emphasizes the importance of promptly identifying and treating life-threatening injuries to the chest.
Aetiopathogenesis and management of empyema thoracis
The document discusses empyema thoracis, beginning with definitions and a brief history. It describes the stages of empyema development from parapneumonic effusion to organized empyema. Common causes include bacterial pneumonias. Diagnosis involves pleural fluid analysis and imaging. Management includes antibiotics, drainage, and surgery if drainage fails. Surgical options range from VATS to open procedures depending on severity.
Bronchiectasis final
Bronchiectasis is a chronic lung condition characterized by abnormal dilatation of the bronchi. It occurs due to destruction of the elastic and muscular components of the bronchial wall from repeated pulmonary infections. Common causes include cystic fibrosis, pneumonia, tuberculosis, and allergic bronchopulmonary aspergillosis. Symptoms include chronic cough with purulent sputum, pneumonia, hemoptysis, and poor health. Diagnosis involves sputum culture, chest x-ray, and high-resolution CT scan of the chest. Management includes chest physiotherapy, antibiotics, and sometimes surgery for uncontrolled infections or hemorrhage. Complications can include recurrent lung infections, abscesses, and respiratory failure.
Chest trauma
This document provides an overview of chest trauma, including:
- Common injuries like pneumothorax, hemothorax, flail chest and their signs and symptoms.
- Assessment involves clinical exam, chest x-ray and ultrasound to detect injuries. Chest tube insertion can be both therapeutic and diagnostic.
- "Deadly dozen" life-threatening injuries from chest trauma include tension pneumothorax, cardiac tamponade, aortic disruption and others that often require emergency procedures or surgery.
- Management involves airway control, ventilation, chest tube drainage, analgesia and monitoring for complications like respiratory failure. Operative treatment is indicated for severe injuries or those not responding to initial management.
Tension Pneumothorax
Tension Pneumothorax, Emergency Medicine Block 5.4
College of Medicine, King Faisal University
Al-Ahsa, Saudi Arabia
Lung Abscess
Lung abscess is a necrotic pulmonary infection that forms cavities containing fluid or debris. It is usually caused by microbial infection following aspiration or pneumonia. Without treatment, lung abscess was often fatal, but antibiotics have greatly improved outcomes. Most lung abscesses are now cured with prolonged antibiotic therapy targeting the usual culprits of anaerobic bacteria and occasionally aerobic pathogens. Imaging helps confirm the diagnosis and monitor response to medical management, with surgery rarely needed for uncomplicated cases.
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Pyothorax, or empyema thoracis, is an accumulation of pus in the pleural cavity that is usually caused by bacterial pneumonia. It progresses through three stages - exudative, fibrinopurulent, and organizing. Symptoms include chest pain, cough, fever, and shortness of breath. Diagnosis involves chest x-ray, CT scan, and thoracentesis of pleural fluid. Treatment requires antibiotics, drainage of pus from the pleural space, and sometimes surgical procedures like VATS to debride the pleural space and allow for lung re-expansion. Complications can include bronchopleural fistula, spread of infection, and sepsis.
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Antenatal and post natal management of congenital diaphragmatic
1) Congenital diaphragmatic hernia results from a developmental defect in utero that causes abdominal organs to protrude into the chest cavity, compressing lung development.
2) Prenatal diagnosis is now possible using ultrasound and MRI, allowing for monitoring and in some cases experimental fetal surgery.
3) After birth, infants receive respiratory support, treatments for pulmonary hypertension if needed, and surgery to repair the diaphragmatic defect when stable, with an overall survival rate now of 70-90% though long term outcomes vary.
Congenital diaphragmatic hernia
Congenital diaphragmatic hernia is a neonatal emergency that occurs when abdominal organs push into the chest cavity through a defect in the diaphragm. It has traditionally had high mortality rates, but preoperative stabilization techniques including nitric oxide, high frequency ventilation, ECMO, and permissive hypercapnia have reduced mortality to under 75%. The presentation depends on when during fetal development the hernia occurred. Treatment involves preoperative stabilization followed by surgical repair once stabilized, with postoperative care focused on managing pulmonary hypertension and hypoplasia. Prognosis depends on the degree of lung and heart hypoplasia and presence of other defects.
PRIMARY EVALUATION OF TRAUMA PATIENTS
Trauma is a global problem and continues to be a leading cause of disability and death.
Approximately 25% to 30% of deaths caused by trauma can be prevented when a systematic and organized approach is used.
The main goal of the initial assessment
Recognize the patient who does have life-threatening injuries
Establish treatment priorities, and
Manage them aggressively
aemt-transition---unit-37---chest-trauma.ppt
This document discusses chest trauma, including epidemiology, pathophysiology, assessment findings, differential diagnosis, and emergency medical care. It provides case studies to illustrate key points. Regarding pathophysiology, it describes how conditions like tension pneumothorax, open pneumothorax, flail chest, and hemothorax can occur from chest trauma and affect ventilation and circulation. Emergency medical care focuses on maintaining the airway, breathing, and circulation while providing full immobilization and rapid transport. Case studies demonstrate assessing and managing a potential chest trauma patient.
aemt-transition---unit-37---chest-trauma.ppt
This document discusses chest trauma, including epidemiology, pathophysiology, assessment findings, differential diagnosis, and emergency medical care. It provides case studies to illustrate key points. Regarding pathophysiology, it describes how conditions like tension pneumothorax, open pneumothorax, flail chest, and hemothorax can occur from chest trauma and affect ventilation and circulation. Emergency medical care focuses on maintaining the airway, breathing, and circulation while providing full immobilization and rapid transport. Case studies demonstrate how to assess and manage a patient with a potential chest injury from an arrow wound.
NnnnnNeonatal Resuscitation shortttt.pdf
This document provides guidelines for neonatal resuscitation. It discusses the importance of resuscitation in improving outcomes for newborns, covering the ABCs which include clearing the airway, stimulating breathing, and assessing circulation. It describes the normal transition that occurs at birth and what can go wrong, such as inadequate breathing or blood flow issues. The key principles of anticipation and assessment of oxygen need are covered. The indications and techniques for positive pressure ventilation and chest compressions are outlined, as well as when medications may be required.
Congenital diaphragmatic hernia
Congenital diaphragmatic hernia (CDH) is a birth defect where abdominal organs protrude into the chest cavity through an opening in the diaphragm. There are three main types - Bochdalek (most common), Morgagni, and hiatal hernias. CDH occurs when the diaphragm fails to fully develop, usually resulting from defects in the pleuroperitoneal membranes or diaphragmatic musculature. Prenatal ultrasound can detect over 70% of CDH cases. Postnatal management focuses on gentle ventilation strategies and optimizing the infant's condition before surgical repair of the diaphragmatic defect. Outcomes are best when care is provided at specialized
Chest trauma for Nurse.pptx
1) Chest trauma is a common cause of injury and death, especially from road traffic accidents, gunshot wounds, and falls.
2) The initial evaluation and resuscitation of chest trauma patients follows the ATLS protocol, assessing the ABCDEs: Airway, Breathing, Circulation, Disability, and Exposure.
3) Common chest injuries include pneumothorax, hemothorax, and flail chest. Tension pneumothorax requires immediate needle decompression. Management involves chest tube placement, oxygen, monitoring, and treatment of underlying conditions.
Neonatal resuscitation guidelines 2015
The document summarizes new additions and guidelines in neonatal resuscitation based on recent evidence. Key points include: recommending delayed cord clamping for term and preterm infants; maintaining normothermia between 36.5-37.5°C; using low oxygen (21-30%) for resuscitating preterm infants under 35 weeks; considering CPAP initially over intubation for respiratory distress in preterm infants; and structuring educational programs to teach resuscitation every 6 months for better performance and confidence.
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The document discusses trauma teams and their roles. It defines a trauma team as a multidisciplinary group that works together to assess and treat severely injured patients. A team approach has been shown to significantly reduce resuscitation times compared to individual doctors. The roles of trauma team members are outlined, as well as techniques for effective communication, briefing, handover, and speaking up if concerns arise. Statistics from Western Australia in 2015 show the most common causes of death for major trauma patients were head injuries and brain death. Overall mortality rates were lower than the national average.
Haemostatic resuscitation
This document provides an overview of haemostatic resuscitation for trauma patients. It discusses the goals of haemostatic resuscitation which include rapidly correcting hypothermia, hypocalcaemia, acidosis and other factors impairing haemostasis. It also aims to resuscitate patients with a balanced combination of blood products resembling whole blood to avoid dilutional coagulopathy. The document reviews the components of blood, various blood products used in resuscitation and their effects, and studies supporting haemostatic resuscitation approaches. It also discusses practical considerations for haemostatic resuscitation in the emergency department setting.
Arthrocentesis
Mr. Arthur Ritis, a 52-year-old man with diabetes, hypertension, and a history of gout, presented with a hot, swollen, and painful right knee for 24 hours. Examination found a warm knee with a large effusion and mild tenderness. Blood tests showed elevated white blood cell count and C-reactive protein. Arthrocentesis of the knee found cloudy yellow synovial fluid containing urate crystals on microscopy. This confirms the diagnosis of an acute gout attack in the knee requiring treatment.
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This document discusses the use of echocardiography during cardiac arrest and peri-arrest situations. It provides an overview of basic echo views that can be useful. Echo can help identify the cause of arrest such as tamponade, pulmonary embolism, or wall motion abnormalities. Findings on echo such as hypovolaemia or myocardial activity can help guide management decisions. The document reviews where echo fits within the ACLS algorithm and issues surrounding its use during cardiac arrest. It provides examples of echo findings that may indicate treatable versus non-treatable causes of arrest.
Goals of patient care introduction
The document discusses the goals of implementing a new Goals of Patient Care (GOPC) form across hospitals in Western Australia to improve end-of-life care and decision making. It provides background on the form's trial implementation at various sites. The new form aims to have goals of care discussions with patients or their surrogates to determine appropriate treatment based on probable outcomes, not just resuscitation status. It outlines the form's structure with sections on baseline information, goal of care selection, discussion summary, and extended use. The document emphasizes improving communication around goals of care and ensuring treatment aligns with patients' values and preferences.
Physiology Directed CPR
This document discusses physiology directed CPR and haemodynamically directed CPR. It notes that cardiac arrest is not a diagnosis and various underlying pathologies must be considered. During closed chest compressions, a proportion of cardiac output is generated through cardiac and thoracic pumping. Studies show that targeting specific blood pressure and coronary perfusion pressure goals during CPR improves survival outcomes compared to standard AHA guidelines. Monitoring diastolic blood pressure and central venous pressure can help guide interventions like fluid administration or vasopressor use to meet haemodynamic targets and optimize circulation during CPR.
Ultrasound confirmation of ETT placement
This document discusses using ultrasound to confirm endotracheal tube placement. It states that ultrasound is a simple, fast, and reliable adjunct technique that can be used when other confirmation methods like capnography are unreliable or not available. There are two ultrasound techniques described - direct (transtracheal) ultrasound looks inside the trachea or esophagus to see if the tube is correctly placed, while indirect (transthoracic) ultrasound looks for movement of the pleura indicating lung ventilation. Ultrasound is not meant to replace capnography and auscultation but can be a helpful additional method in emergency situations or for patients who are not responding as expected after intubation. The document provides details on how to
Palliative care in the emergency department
This document provides guidance on symptom management for palliative patients in the emergency department. It outlines approaches for managing common symptoms like pain, delirium, dyspnea, nausea and vomiting. It recommends opiate medications for pain management, depending on whether the patient is opiate naïve or tolerant. It also provides guidance on managing other symptoms like bladder and bowel issues, secretions and more uncommon complications. The document emphasizes the importance of palliative care consultation and ensuring patients are not left to die alone.
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Patient confidentiality in emergency department
Patient confidentiality must be maintained in the ED. Personal information about patients cannot be disclosed without consent, except in emergencies or if required by law. Duty consultants should be aware of any VIP patients but provide the same standard of care. Confidentiality must be respected even for those not under the practitioner's direct care. Mandatory notifications to regulatory bodies are required only for specific conduct issues. Advice can be sought from designated hospital staff if questions arise about disclosing information.
Abscess management
This document summarizes several studies on the use of antibiotics for abscess management. A 2016 RCT of over 1000 patients found that high-dose Bactrim led to higher cure rates of abscesses over 2cm compared to placebo, especially for those with MRSA, fevers, or immunosuppression. A 2017 RCT of under 800 patients found Bactrim and clindamycin had similar cure rates of abscesses under 5cm as placebo. However, antibiotics were associated with higher adverse gastrointestinal events. Overall, meta-analyses show antibiotics reduce treatment failures and new skin infections compared to incision and drainage alone, but with a risk of serious drug side effects.
Hyperthermia and hypothermia
This document discusses hyperthermia and hypothermia. It defines hyperthermia as a core body temperature above 41.5°C and describes the pathophysiology and various causes, including exercise-associated collapse, heatstroke, and drug-related illnesses. It also discusses hypothermia, defined as a core temperature below 35°C, and covers causes, clinical features at different temperature stages, complications, investigations, and management approaches including warming techniques. The prognosis depends on factors like maximum temperature reached and duration of temperature elevation.
Electrical injury
- This document contains information on various electrical injury cases presented to the emergency department, including details on mechanisms of injury, clinical presentations, investigations, and management strategies. Key points include treating electrical injury patients as trauma patients, avoiding premature withdrawal of resuscitation due to the unreliable signs of death, monitoring for cardiac dysrhythmias, rhabdomyolysis, and neurovascular compromise of injured extremities. High voltage or lightning injuries can cause severe internal injuries despite minor external burns and require prolonged cardiac monitoring and aggressive IV fluid resuscitation.
D-dimer audit
This document summarizes an audit of CTPA scans ordered without a D-Dimer test for patients over 50. Of 53 CTPA scans reviewed, 49 did not have a D-Dimer. For most scans, the decision not to order a D-Dimer was appropriately documented. However, for 8 scans (16%) there was no documented reason for not ordering a D-Dimer. The audit concluded that CTPA scans are generally being ordered appropriately to diagnose PE, but better documentation of the reasons for not ordering D-Dimers could help reduce unnecessary CTPA use.
It's all about the documentation
Good clinical documentation is critical for continuity of patient care, patient safety, legal records, and supporting accurate medical coding. The documentation provides information on why the patient was admitted and what treatments they received. The coders assign diagnosis and procedure codes based solely on the documented information. Ambiguous or incomplete documentation can result in inaccurate coding that affects funding. Ensuring documentation clearly specifies diagnoses, management plans, and interventions helps ensure patients are assigned to the appropriate Diagnosis Related Group (DRG) and the hospital receives appropriate funding for the services provided.
Paediatric rashes
This document provides an overview of common paediatric rashes. It begins with describing the anatomy of the skin and definitions of common rash morphologies such as macules, papules, vesicles and pustules. Common rashes that are described include scabies, acne, contact dermatitis, atopic dermatitis, impetigo, tinea and nonspecific viral rashes. Specific viral exanthems like measles, rubella and scarlet fever are also reviewed. Emergent rashes like erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis are discussed in terms of their presentations, causes and treatments. References are provided at the end.
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This document summarizes a case study of a 28-year-old Australian woman who developed a rash and respiratory symptoms after returning from travel to Thailand. Initial testing ruled out common infections like malaria, dengue fever, and influenza. Her rash and symptoms were consistent with measles. Further diagnostic testing confirmed infection with herpes simplex virus 1 via a positive PCR test. The case highlights the importance of considering uncommon infections in returning travelers who present with rashes and respiratory symptoms.
What's Hot in Emergency Medicine June 2018
This document summarizes several hot topics in emergency medicine:
1) A study found imaging and blood cultures are often inappropriate for evaluating uncomplicated cellulitis according to guidelines.
2) A new pulmonary embolism pathway was introduced in 2018.
3) The Surviving Sepsis Campaign updated their sepsis bundles to a single 1-hour bundle in 2018.
4) There is debate around the evidence and recommendations of the Surviving Sepsis Campaign.
5) The terms used to describe new oral anticoagulants, like NOAC, are still appropriate according to hematology experts.
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- The presentation notes that the value of experience is not just seeing much, but seeing wisely. It asks if the viewer sees what the presenter sees.
- A list of time-critical conditions that require urgent attention is provided, including acute angle closure glaucoma, penetrating eye injuries, endophthalmitis, and retinal artery occlusion.
Code Brown - Disaster Medicine in the ED
The document outlines the emergency department's response plan for a "Code Brown", which refers to mass casualty incidents that exceed the hospital's normal capacity. The 4 phases of response are notification, standby/preparation, reception of casualties, and stand down. Key steps include activating staff call backs, setting up triage and treatment areas, prioritizing patient care, and addressing issues like family inquiries, transportation bottlenecks, and media relations. The plan emphasizes timely triage, treatment and flow of patients. A post-incident debriefing within 7 days allows for evaluating the response and making improvements.
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Managing pneumothorax
- 2. Pneumothorax • Spontaneous or Traumatic • Primary or Secondary • Old or Young (patient) • Breathless or Not • Big or Small • Admit or Discharge • Aspirate or Drain (big or small)
- 3. 21 Male, sudden pleuritic chest pain, mild SOB. Fit + Well
- 5. Spontaneous Pneumothorax • Why is secondary important – Increased mortality – Increased morbidity • Why size matters – 2cm cut off has been chosen as compromise between risks of intervention and length of time to resolution – 2cm estimated to mean loss of 50% volume of hemithorax – Rate of resolution = 2% hemithorax in 24 hrs – Therefore 2cm = 25 days (without leak)
- 6. ED Treatment Options • Oxygen – Decreases time to resolution 4 fold • Simple aspiration – 2nd intercostal space midclavicular line? • Chest drain – Small bores recommended (F10-14) • Better tolerated and no evidence larger is better – Triangle of safety – 2nd intercostal space mid clavicular line in apical
- 7. Discharge Advice • Return if SOB • No flying until complete resolution – Airlines arbitrarily say at least 6 weeks – Some say at least 1 week after complete resolution – Risk of recurrence reduces significantly after 1 year • Avoid sports until complete resolution • No scuba diving – Unless cleared to do so – Undergone bilateral surgical pleurectomy, has normal lung function and chest CT • Stop smoking – Increased risk of recurrence
- 8. Follow Up • All patients should be followed up by a respiratory physician • 2 – 4 weeks to ensure complete resolution • Failure to re-expand within 24 hours with drain suggests air leak referral to respiratory physician – Suction – Drain repositioning • Failure to re-expand at 3-5 days suggests persistant air leak Thoracic surgeons
- 9. 1am, 25 male. L sided chest pain, x1 previous pneumothorax
- 11. 68 Female. SOB and chest pain. COPD
- 13. 26 female, 19 weeks pregnant, chest pain, slight SOB
- 15. When Else to Involve Specialist Early • Recurrent pneumothorax (2nd ipsalateral or 1st contralateral pneumothorax) • Bilateral pneumothorax • Professions at risk (Diving, Pilots) • Pregnancy – Involvement of obstetrics and thoracic surgeons early – High risk recurrence therefore aim to avoid chest drain
- 16. 25 male. Fallen off bike. L chest Pain
- 17. Traumatic Pneumothorax • Often require treatment with chest drain • Management of occult pneumothorax – No lung edge seen on chest x-ray • Supine • Small – Often picked up on CT chest • Require intervention (drain) if intubation is required or patient symptomatic • Can be treated with observation and oxygen
- 18. Definitive Treatment Options • Open thoracotomy • VATS (Video-assisted thoracoscopic surgery) • Surgical chemical pleurodesis • Medical pleurodesis – Less effective
- 19. Summary • Spontaneous and traumatic can be treated similarly • Patients age, medical state, level of breathlessness and size of pneumothorax are main deciding factors • There are several treatment options – Can we just leave it to the patient to decide what they want?