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Semester 3 - respiratory > 16. Pneumothorax > Flashcards

16. Pneumothorax Flashcards

1
Q

What is a pneumothorax?

A

Presence of air between the visceral and parietal pleura(pleural cavity)

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2
Q

What is the result of air within the pleural cavity?

A

Disuption of the pleura -> air flows from higher pressure to lower pressure -> disruption of the balance between outward recoil of chest wall and inward recoil of lung -> lung collapses.

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3
Q

What are the 3 ways of classifying pneumothorax?

A

 Simple VS Tension pneumothorax
 Primary VS Secondary pneumothorax
 Spontaneous VS Iatrogenic VS Traumatic pneumothorax

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4
Q

Where can the air come from in a pneumothorax?

A
  • the lung
  • through chest wall
  • both
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5
Q

Compare simple and tension pneumothorax

A

Simple
• Haemodynamic stable patients

Tension
• Causes haemodynamic instability
• Caused by the one-way flow of air. - air accumulates in pleural cavity and not drained out

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6
Q

contrast primary and secondary pneumothorax

A

Primary
• No underlying lung pathology
• Spontaneous

Secondary
• Underlying lung pathology

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7
Q

What are the risk factors for primary pneumothorax?

A
  • Male
  • Young
  • Family history of pneumothorax
  • Smoking (9x risk)
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8
Q

What are the underlying lung pathologies in secondary pheumothorax?

A
  • COPD (70%)
  • Asthma
  • Bronchiectasis – inc cystic fibrosis
  • Lung cancer
  • Infections : TB, pneumonia
  • Marfan’s syndrome, Ehler’s Danlos syndrome
  • RA
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9
Q

What are the possible causes of pnuemothorax?

A
  • spontaneous
  • iatrogenic
  • trauma
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10
Q

Describe how spontaneous pnuemothorax occurs?

A
  • spontaneous = primary

* Usually due to subpleural blebs / bulla (air-filled sac) that bursts, allowing air into the pleural cavity

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11
Q

Describe how iatrogenic pnuemothorax occurs?

A

caused by invasive medical procedures e.g. - central vein cannulation, pleural tap or biopsy, transbronchial biopsy, fine needle aspiration, pacing

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12
Q

Describe how trauma pnuemothorax occurs?

A

• Severe chest wall injury -> stab wound or gunshot
wound -> allows air to enter the pleural space
• Rib fractures -> puncture the visceral pleura

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13
Q

What do the 3 classifications of pneumothorax tell you?

A
  • Simple VS Tension pneumothorax = ?emergency
  • Primary VS Secondary pneumothorax = ?underlying lung disease
  • Spontaneous VS Iatrogenic VS Traumatic pneumothorax = aetiology
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14
Q

Describe how pneumothorax can be split?

A

• simple:

  • primary
  • secondary

• tension

primary and secondary can develop into tension

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15
Q

Describe the classical presentation of simple pneumothorax

A 
 Chest pain
- Pleuritic in nature
- Sudden onset
- Sharp pain
 +/- SOB
 History of trauma/lung disease
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16
Q

What are the results of a respiratory examination of a patient with simple pnuemothorax?

A 
• Trachea deviation:
normal
• Chest movement:
Reduced on affected side
• Percussion note:
Hyper- resonant or resonant on affected side
• Breath sounds(Auscultation):
reduced /absent on affected side
• Vocal/tactile resonance:
Reduced on affected side
17
Q

What is seen on a CXR of simple pneumothorax?

A

 Hyper-lucent (ie appear darker)
 Absent lung markings(beyond edge of collapsed lung)
 Collpased lung borders seen

18
Q

What is seen on a CT of simple pneumothorax?

A

 Absent lung markings

 Collapsed lung borders seen

19
Q

What is the treatment for asymptomatic pneumothorax patients?

A

Usually don’t require treatment, air is absorbed into the blood vessels - conservative treatment

20
Q

What is the treatment for symptomatic simple pneumothorax patients?

A

Symptomatic

  • and has a small pneumothorax : needle pleural aspiration may be sufficient
  • and has a large pneumothorax: insertion of chest drainage.
21
Q

Where is the safe triangle for chest drainage?

A

Between lateral borders of Pec major and Lat dorsi, above nipple line
• Superior: Base of the axilla
• inferior: 5th Intercostal space/6th rib
• In the mid-axillary line
• Just above 6th rib, to avoid neurovascular bundle

22
Q

Describe how the chest drain works?

A

Connected to underwater seal

  • bubbles indicate air being released from pleural space
  • bubbles stop = air removed
  • under water seal ensures air doesn’t enter pleural space through tube
23
Q

What is a tension pneumothorax?

A

can occur due to any aetiology and is defined as any size of pneumothorax causing mediastinal shift and cardiovascular collapse.

24
Q

Why do tension pnuemothorax occur?

A

Occurs whenever air can enter the pleural cavity on inspiration, but cannot escape on expiration because of the development of a one-way valve system at the site of the breach in the pleural membrane

25
Q

What are the effects of tension pneumothorax on lungs and CVS?

A
  • intrapleural pressure increases above atmospheric pressure
  • Compresses normal lung
  • Venous return impaired, therefore cardiac output drops
  • results in hypoxaemia and haemodynamic compromise
26
Q

What are the presenting symptoms of tension pneumothorax?

A 
•  Chest pain
- Pleuritic in nature
- Sudden onset
- Sharp pain
•  +/- SOB
•  History of trauma/lung disease
\+
•  Respiratory distress
•  Cyanosis
•  Marked tachycardia
•  Marked hypoxemia
•  tachypnoea
•  hypotension
27
Q

What are the results of a respiratory examination of a patient with tension pnuemothorax?

A 
• Trachea deviation:
 Away from the affected side
• Chest movement:
Reduced on affected side
• Breath sounds(Auscultation):
reduced /absent on affected side

No time for other test - emergency
but percussion would be hyper-resonant

28
Q

What is the treatment for tension pneumothorax?

A

Emergency needle decompression of the chest:

Insert a plastic cannula (Venflon) into the second intercostal space in the mid-clavicular line.
Cannula left in place till chest drain inserted (in the 4th ICS mid axillary line) when patient is
stable

Semester 3 - respiratory (20 decks)

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