An emergency room patient is lying on his bed with his head ...

[bclement10]

An emergency room patient is lying on his bed with his head elevated at a 45-degree angle. An RT, who is coming to examine the patient, notices that the patient's jugular vein extends ap-proximately 7 cm above his sternal angle.
 
  What can the RT assume about this patient's condition?
  a. Cor pulmonale
  b. Pneumonia
  c. Kussmaul's sign
  d. Pneumothorax

Question 2

An RT is examining a patient suspected to have a left-sided tension pneumothorax. During in-spection and palpation, the RT notices the patient's trachea has shifted to the left. Is the patient's diagnosis correct?
 
  a. Yes, the patient may have left-sided ten-sion pneumothorax.
  b. No, the patient may have left upper lobe atelectasis.
  c. No, the patient may have right lower lobe pneumonia.
  d. No, patient may have left-sided large pleural effusion.

[eliasc0401]

Answer to Question 1

ANS: A
When lying in a supine position, a healthy individual has neck veins that are full. When the head of the bed is elevated gradually to a 45-degree angle, the level of the blood column descends to a point no more than a few centimeters above the clavicle. With elevated venous pressure, the neck veins may be distended as high as the angle of the jaw, even when the patient is sitting upright. Jugular venous distention (JVD) is present when the jugular vein is enlarged and it can be seen more than 3 to 4 cm above the sternal angle. The most common cause of JVD is heart failure (cor pulmonale). Heart failure frequently occurs with advanced COPD because of hypoxemia. This causes chronic pulmonary vasoconstriction and hypertension which leads to right heart failure from the excessive workload. Other conditions associated with JVD include left heart failure, cardiac tamponade, tension pneumothoraces, and mediastinal tumors.

Answer to Question 2

ANS: B
The trachea shifts away from areas with increased air, fluid, or tissue (e.g., in tension pneumo-thorax or large pleural effusion) and toward atelectasis. In general, abnormalities in the lung bases do not shift the trachea.

[bclement10]

TYSM

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