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Parietal pleura is sensitive to
pain, temp, touch, and pressure
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Nerve supply of parietal pleura
lower intercostal nerve, phrenic nerve, and
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Nerve supply of visceral pleura
ANS from pulmonary plexus
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Visceral pleura is sensitive to
stretch
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Pleural space
potential space between visceral and parietal pleura that contains a lubricating fluid
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What happens when pleural space is filled with air or fluid?
work of breathing increases
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Hydrothorax
accumulation of fluid withint hte pleural cavity (pleural effusion)
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Thoracentesis
Procedure to remove hydrothorax (therapeutic or diagnostic)
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Empyema
Pus in pleural cavity
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Hemothorax
Blood in pleural cavity
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Which injured vessels/structures cause a hemothorax?
thoracocromial artery, lateral thoracic artery, intercostal vessels, internal thoracic artery, mediastinal great vessels, heart and lungs, and abdominal structures
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Pleurodesis
Pleural poudrage; chemically and physically causing the parietal and visceral layers of pleura to stick together (uses talc)
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Pleurisy
inflammation of the pleura causing pain with respiration; can hear pleural friction rub (can be viral)
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Pleural adhesions
results from pleurisy; caused with pneumonia when the pleural surfaces can get coateed with inflammatory exudate causing the surfaces to become roughened;
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How are pleural adhesions formed?
invaded by fibroblasts which lay down collagen and bind visceral pleura to the parietal pleura
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pneumothorax
entry of air into the pleural cavity
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How does penumothroax occur?
spontaneous (from rupture of a bleb) or secondary to trauma
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Types of pneumothorax
open, closed, tension
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Open pneumothorax
Open connection between pleural cavity and outside world (air moves in and out with inspiration and expiration); lung collapses due to lack of negative pressure
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Closed pneumothorax
Fixed amount of air in pleural cavity which does not increase or decrease with inspiration or expiration; lung cannot fully expand due to physical space air takes up in cavity and air in pleural cavity will be reabsorbed
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Tension pneumothorax
"one-way valve" - air enters pleural cavity during inspiration but is unable to exit during expiration; creates a flap that opens with inspiration
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What does tension pneumothorax cause?
Rapid lung collapse, hypoxia, and shock due to rapid compression of great veins
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Why is a tension pneumothorax so bad?
Contiual leak deviates the mediastinum to the contralateral side, needs immediate decompression by a chest tube
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Tube thoracostomy
Procedure done in parents with tension pneumothorax or to drain fluid away from the pleural cavity to allow the lung to re-expand
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Where is tube thoracostomy insertion site?
4th or 5th intercostal space at the anterior axillary line
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How is a tube thoracostomy done?
Tube is inserted through a small incision after infiltration of area with local anesthesia, kelly tube is inserted into skin incision and angled over the rib to pierce it through the parietal pleura, insert gloved finger to verify position, insert chest tube with the aid of the Kelly clamp, attach tube to suction unit and suture in on patient
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