14. Pneumothorax Flashcards
What is a pneumothorax?
Collapse of a lung due to air being in the pleural space
What are the casues of a pneumothorax?
Spontaneous (young thin men due to rupture of subcutaneous bulla) Chronci lung disease Infection Traumatic Carcinoma Connective tissue disorder
What are the symptoms of a pneumothorax
sudden dyspnoea
sudden chest pain
sudden deterioration in asthma/COPD
What are the signs of a pneumothorax?
Reduced expansion, hyper reasnance to percuss, diminished breath sounds on affected side
What tests should be done if a pneumothorax is suspected?
CXR- only if indicated, check for tension pneumothorax beforehand
ABG-
What is the treatment of a primary pneumothorax?
Aspirate pneumothorax to try and release air and reinflate lung
If aspiration unsuccessful then chest drain is required.
If there is no SOB and less than 2cm of air exists then consider review and discharge
What is the treatment of a secondary pneumothorax?
If bigger than 2cm- chest drain
If 1-2cm and aspiration unsuccessful- chest drain
If 1-2cm and aspiration successful- admit for 2h for observation and Oxygen
Traumatic pneumothorax and ventilation induced pneumothorax will need
When should surgical management of a pneumothorax be considered
Bilateral pneumothoraces
After 48 hours chest drain hasn’t shown signs of re-inflation
persistant air leak
Two or more previous pneumothoraces on the same side
What is a tension pneumothorax?
A medical emergency
Air has been drawn into the pleural space during inspiration and has no route of escape during expiration
Cardiorespiratory arrest will occur unless air is rapidly removed
What are the signs of a tension pneumothorax?
TRACHEAL DEVIATION
Respiratory distress, tachycardia, hypotension, distended neck veins, reduced air entry on affected side
How do you treat a tension pneumothorax?
Insert a large bore needle (with saline) and stab it in the chest. Then insert a chest drain
