04 - Pneumothorax

Question 0

What determines the negative outcome of a pneumothorax?

Answer 0

The size of the pneumothorax

Question 1

In the normal state, the pleural space is like a

Answer 1

Sealed container

Question 2

What is a pneumothorax? What is it caused by?

Answer 2

An abnormal collection of air in the pleural space that adds pressure around the lungs, preventing their normal excursion
Caused by violating the pleura

Question 3

Removal of negative pressure in the pleural space causes

Answer 3

Lung collapse

Question 4

When a person is upright, is there more negative pressure at the top or at the base of the lungs?

Answer 4

At the top

Question 5

The flow of air during a pneumothorax

Answer 5

Either air flows out from the lungs or air flows into the lungs from outside of the chest

Question 6

How does a pneumothorax affect a person’s ability to breath?

Answer 6

It prevents the generation of negative pressure in the lungs, causing collapse

Question 7

What is a tension pneumothorax?

Answer 7

Accumulation of pressure in the pleural space because there is a hole in the pleura but no hole in the chest wall

Question 8

Pneumothorax categories

Answer 8

Spontaneous: primary and secondary
Traumatic: penetrating and iatrogenic
Tension

Question 9

Difference between a primary and secondary spontaneous pneumothorax?

Answer 9

Primary occurs from no apparent cause, in the absence of significant lung disease - can occur from a stressful cough (smoking)
Secondary occurs for rupture of alveoli not from direct injury - emphysema or acute resp distress syndrome

Question 10

Traumatic pneumothorax are caused by

Answer 10

Blunt force injury

They can be penetrating or (and??) iatrogenic

Question 11

A tension pneumothorax can be accelerated by

Answer 11

Mechanical ventilation

Question 12

Signs and symptoms of pneumothorax

Answer 12

Acute onset dyspnea, chest pain, hypotension, tachycardia, pulsus paradoxus, tracheal deviation

Question 13

What’s the best way to diagnose a pneumothorax?

Answer 13

X-Ray

Question 14

How does a pneumothorax cause hypotension?

Answer 14

The pressure prevents blood flow back to the heart. This is especially true with a tension pneumo

Question 15

Why does a pneumothorax cause tachycardia?

Answer 15

From the pain, compensation for low cardiac output, or hypoperfusion

Question 16

What is pulsus paradoxus?

Answer 16

Abnormal accentuation of respiratory variation that usually occurs when the patient is dehydrated
Characterized by >10 mmHg decrease in BP during inspiration

Question 17

What is the mechanism of pulsus paradoxus?

Answer 17

Negative intrathoracic pressure causes increased systemic venous return and dilates vasculature, pooling blood in the lungs. This causes decreased pulmonary venous return, resulting in less blood flow to the let side of the heart. The end result is decreased stroke volume.

Question 18

Increased sustemic venous return to the right side of the heart expands the right side and compromises

Answer 18

Filling of the left side of the heart

Question 19

Why does HR increase when systolic BP decreases?

Answer 19

Baroreceptor reflex

This is also an effect of pulsus paradoxus

Question 20

What is used to treat a pneumothorax?

Answer 20

Pleur-evac

Question 21

How does a pleur-evac work?

Answer 21

The pleur-evac restores the negative pressure in the pleural space. The chest wall is sealed as the tube is removed.

Question 22

What is a subcutaneous emphysema?

Answer 22

Air from a pneumothorax gets under the skin… Feels like Rice Krispies. Ew.