1(E): Pneumothorax Flashcards
Define pneumothorax
Air with the pleural space
What is a primary pneumothorax
Pneumothorax with no underlying lung disease
What is a secondary pneumothorax
Pneumothorax with underlying lung disease
In which gender is primary pneumothorax more common
Male
Which age group is primary pneumothorax more common
20-30 years
Which age-group is secondary pneumothorax more common
60-70 years
What causes primary pneumothorax
- Connective Tissue Disease: Ehlers-Danlos, Marfans
2. Trauma
What causes secondary pneumothorax
Underlying lung disease:
- COPD (emphysema)
- Asthma
- TB
- Pneumonia
- Carcinoma
- CF
What can cause an iatrogenic pneumothorax
- CVC line insertion
- Pleural aspiration
- Biopsy
- Liver Biopsy
- Mechanical ventilation
What is the stereotype for primary pneumothorax
Tall, thin male
What are 3 risk factors for primary pneumothorax
- Tall, thin male
- Smoking (20-times risk)
- FH
Describe symptoms of pneumothorax
Sudden-onset:
- Dyspneoa
- Pleuritic chest pain
What are signs of pneumothorax on auscultation
Reduced breath sounds
What are signs of pneumothorax on percussion
Hyper-resonant to percussion
What is the main feature of a tension pneumothorax
Tracheal deviation
How may the chest appear in a tension pneumothorax
Reduced chest expansion (asymmetrical)
What are symptoms of tension pneumothorax
- Respiratory distress (cyanosis, hyperventilation)
- Haemodynamic compromised
What is a mnemonic to remember features of pneumothorax
P-THORAX
What are features of pneumothorax (P-THORAX)
Pleuritic chest pain Tracheal deviaiton Haemodynamic compromise Onset sudden Reduced breath sounds Absent fremitus X-ray shows collapse
What causes a tension pneumothorax
Air enters pleural space however cannot exit due to tissue forming a one-way valve system meaning air can enter pleural space but cannot leave.
Why does haemodynamic instability occur in tension pneumothorax
Increase pressure causes a mediastinal shift impairing venous return to the heart
What investigations are ordered in pneumothorax
CXR
ABG
Explain presentation of pneumothorax on CXR
- Increase radiolucency on affected side
- On the affected side there is a thin white line - there
are no lung markings peripheral to this - May be evidence of lung collapse
What indications tension pneumothorax on CXR and why shouldn’t this be seen
Mediastinal shift.
CXR should not be ordered in tension pneumothorax
Explain CXR in tension pneumothorax
Tension pneumothorax is a clinical diagnosis - do not order CXR
If an individual is haemodynamically unstable or has bilateral pneumothoraces what is done
Insert chest drain
If patient is haemodynamically stable with pneumothorax what is first-assessed
Whether this is primary or secondary pneumothorax based on:
- Patient Over 50?
- Smoking status?
- Diagnosis of lung pathology?
If primary pneumothorax and greater than 2cm and/or breathless what is done
Aspirate with 16-18G cannula
What is the maximum that should be aspirated at one time
2.5L
If a primary pneumothorax less than 2cm or asymptomatic what is done
Discharge and review as OP in 2-4W
If secondary pneumothorax >2cm and/or person is breathless what is done
Chest Drain
If secondary pneumothorax 1-2cm, what is done
- Aspirate using 16-18G cannula
If aspiration is unsuccessful what should individuals received
Chest drain
What is a successful aspiration in primary pneumothorax
Pneumothorax is less than 1cm and reduction breathlessness
What is a successful aspiration in secondary pneumothorax
Pneumothorax is less than 2cm and reduction in breathlessness
What is problem with pneumothorax
High recurrence risk
What can pneumothorax cause
- Resp Failure
- HF (Tension Pneumothorax)
If pneumothorax is less than 1cm in secondary pneumothorax, what is done
Admit for 24h for observations and oxygen
