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54

Peak Inspiratory Pressure: Physiological Determinants

Peak inspiratory pressure (PIP) the center of a great deal of discussion of ventilator management.&nbsp;&nbsp; Knowing the factors that increase or decrease PIP are important to those managing critically ill patient.&nbsp; This podcast is steeped in physiology and perhaps more difficult than my typical podcasts.&nbsp; PIP=&nbsp; [Tv/ (Compliance Lung &amp; Thorax)] + (Resistance of airway + flow )<br/>  
Jeffrey S. Guy, MD, FACS
about 9 years ago
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2
54

Focus On: Ultrasound Detection of Traumatic Anterior Pneumothorax

Early detection of a pneumothorax may be important in the clinical management of a trauma patient. Supine chest radiographs in the immobilized trauma patient have been shown to be insensitive.  
American College Of Emergency Medicine
about 9 years ago
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6
163

Chest x-Ray

Left Sided Pleural effusion. The most common cause of this presentation is malignancy. It is important to consider the source of a possible primary. It may also be necessary to obtain a sample of the effusion fluid to determine whether it is a transudate or an exudate, using Light's criteria as a guide. Exudate contains greater levels of protein than a transudate reflecting it's often inflammatory origin as the blood vessels become 'leaky' to protein molecules. The differential diagnosis for bilateral pleural effusions is different again. Consider 'failure' e.g. heart, renal or hepatic.  
Tim Ritzmann
almost 10 years ago
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4
172

Chest X-ray

Note the calcified granuloma in the right upper zone (an important differential being malignancy). Note also the left lower lobe collapse ('sail sign' behind the heart). If you look closely you will see the abscence of the lower ribs leading you to the conclusion that the patient has, at some point, undergone a thoracotomy. You can also see surgical clips in the stomach.  
Tim Ritzmann
almost 10 years ago
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9
509

CXR - left sided pneumothorax and surgical emphysema

In this Chest X-Ray we can identify a left sided pneumothorax - there is absence of lung markings in the periphery and we can also see a shadow which outlines the edge of the lung. A pneumothorax is caused when air enters the potential space between the viceral and parietal pleura and causes the lung to collapse down under the pressure of it's elsatic recoil. In this case it is likely that the pneumothorax has been caused by trauma as we can see air in the soft tissues on the left side (surgical emphysema - clinically feels like bubble wrap). A pneumothorax can be a life threatening condition. The patient presents in respiratory distress with decreased expansion on the affected side. There will be hyperresonance to percussion on that side but absent breath sounds. The emergency treatment is decompression with a large bore cannula in the 2nd intercostal space mid-clavicular line followed by insertion a chest drain in the 5th intercostal space mid-axilllary line  
Rhys Clement
almost 10 years ago
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1158

Pleural effusion x-ray (left-sided)

This PA Chest X-Ray demonstrates a left sided pleural effusion. In this condition fluid collects between the parietal and visceral pleura and appears as a shadowy fluid level on the X-Ray with obliteration of the costophrenic angles. If you were to examine this patient they might be in respiratory distress from reduced oxygen uptake (so have low sats, high resp rate, possible cyanosis and accessory muscle useage) - they may have reduced chest expansion on the affected side and it would be stony dull to percussion. Fluid transmits sound poorly so breath sounds would be decreased as would vocal resonance/fremitus. Someone with consolidation may have very similar clinical findings but the underlying area of lung is almost solid due to pus from the infective process - as sounds travel well through solids they would have increased vocal fremitus which is how you can clinically differentiate between the two conditions. Clinical examination and understanding of conditions is paramount to practice effective medicine. Before you recieved this X-Ray you should be able to diagnose the condition and use the X-Ray to confirm your suspicions.  
Rhys Clement
almost 10 years ago
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4
261

Haemothorax

This image displays a large left sided haemothorax with mediastinal displacement to the opposite side. Clinically the patient would be in respiratory distress - percussion of the left side of the chest would be dull and breath sounds and vocal resonance would be reduced. A Haemothorax such as this falls into the category of life threatening chest injuries (ATOMFC) and requires emergent treatment using a chest drain in the 5th intercostal space, mid-axillary line and treatment according to ALS or ATLS protocols. ATOMFC = A = airway obstruction, T = tension pneumothorax, O = open pneumothorax, M = massive haemothorax, F = flail chest, C = cardiac tamponade.  
Rhys Clement
almost 10 years ago