1 SYMMETRICAL COMPONENETS OF POWER SYSTEM SYMMETRICAL COMPONENETS OF POWER SYSTEM.
Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant...
-
Upload
norman-lathem -
Category
Documents
-
view
214 -
download
0
Transcript of Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant...
![Page 1: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/1.jpg)
STEPHANIE M. GO
Case 2
![Page 2: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/2.jpg)
5 hrs PTC
VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on
percussion left, absent breath sounds left Apex beat parasternal 5th LICS Flat abdomen, NABS, (-) mass (-) tenderness
34/FChief Complaint: epigastric pain
(+) vague abdominal pain
(-) change in BM Persistence
consult
PhysicalExamination
History of present illness
![Page 3: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/3.jpg)
Patient’s Radiographs
Scout film of the abdomen Chest X-Ray
On interpretation, plain film of the chest was requested by the radiologist
![Page 4: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/4.jpg)
SCOUT FILM OF THE ABDOMEN
![Page 5: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/5.jpg)
Information from a plain scout film:
Presence of calcifications Abnormal gas collection Abnormal size of the liver and spleen Ascites Abnormal gas pattern Abscesses Foreign bodies
![Page 6: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/6.jpg)
Normal Scout Film of the Abdomen
![Page 7: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/7.jpg)
What to examine?
Gas pattern Extraluminal air Soft tissue masses Calcifications
![Page 8: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/8.jpg)
Normal Gas Pattern
![Page 9: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/9.jpg)
Large vs Small Bowel
Large bowel Peripheral Haustral pattern does
not fully traverse the colon
Small bowel Central Valvulae conniventes
![Page 10: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/10.jpg)
SFA correlation
normal patient
![Page 11: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/11.jpg)
CXR correlation
normal patient
![Page 12: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/12.jpg)
PNEUMOTHORAX
Presence of air in the pleural space Anatomy
Visceral pleura is adherent to lung surface
There is no air in the pleural space normally
The introduction of air into the pleural space separates the visceral from the parietal pleura
![Page 13: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/13.jpg)
PNEUMOTHORAX
Pathophysiology Either from disruption of visceral
pleura trauma to parietal pleura
Clinical findings Acute onset of:
Pleuritic chest pain Dyspnea (in 80-90%) Cough Back or shoulder pain
![Page 14: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/14.jpg)
PNEUMOTHORAX
Etiologies: Penetrating trauma Blunt trauma Iatrogenic Spontaneous pneumothorax Other causes of a pneumothorax
Neonatal disease Malignancy Pulmonary infections Complication of pulmonary fibrosis Asthma or emphysema “Catamenial pneumothorax” Marfan’s syndrome Ehlers-Danlos syndrome Pulmonary infarction Lymphangiomyomatosis and tuberous sclerosis
![Page 15: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/15.jpg)
PNEUMOTHORAX
TYPES: Closed pneumothorax = intact thoracic cage Open pneumothorax = "sucking" chest wound Tension pneumothorax
Accumulation of air within pleural space due to free ingress and limited egress of air
Pathophysiology: Intrapleural pressure exceeds atmospheric pressure in lung
during expiration (check-valve mechanism) Frequency
In 3-5% of patients with spontaneous pneumothorax Higher in barotrauma (mechanical ventilation)
Simple pneumothorax –no shift of the heart or mediastinal structures
![Page 16: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/16.jpg)
Imaging findings in PNEUMOTHORAX visceral pleural white line
Very thin white line that differs from a skin fold by its thickness
Absence of lung markings distal or peripheral to the visceral pleural white line
Displacement of mediastinum and/or anterior junction line
Deep sulcus sign On frontal view, larger
lateral costodiaphragmatic recess than on opposite side
Diaphragm may be inverted on side with deep sulcus
Supine position
![Page 17: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/17.jpg)
PNEUMOTHORAX
NORMAL Pneumothorax, R
![Page 18: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/18.jpg)
CXR correlation
normal patient
![Page 19: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/19.jpg)
PNEUMOTHORAX
Pitfalls in diagnosis: Skin fold
Thicker than the thin visceral pleural white line Air trapped between chest wall and arm
Will be seen as a lucency rather than a visceral pleural white line
Edge of scapula Follow contour of scapula to make sure it does not
project over chest Overlying sheets
Usually will extend beyond the confines of the lung Hair braids
![Page 20: Case 2. 5 hrs PTC VS BP 120/90 HR 88 RR 24 T 38.2°C Symmetrical chest expansion, hyperresonant on percussion left, absent breath sounds left Apex.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b4930550346d31b8b4bc2/html5/thumbnails/20.jpg)
THANK YOU!