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3: MED1 Y3 - Respiratory [18] > [3] Pneumothorax > Flashcards

[3] Pneumothorax Flashcards

1
Q

What is a pneumothorax?

A

A collection of air in the pleural cavity (between the lung and the chest wall) resulting in collapse of the lung on the affected side

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2
Q

What is the extent of the collapse in pneumothorax depenent on?

A

The amount of air that is present

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3
Q

What is the thoracic cavity?

A

The space inside the chest that contains the lungs, heart, and numerous major blood vessels.

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4
Q

Describe the pleura in the thoracic cavity

A

The visceral pleura covers the surface of hte lung, and the parietal pleura lines the inside of the chest wall. Normally, the two layers are separated by a small amount of lubricating serious fluid.

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5
Q

Why are the lungs fully inflated in the thoracic cavity?

A

Because the pressure in inside the airways is higher than the pressure inside the pleural space

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6
Q

When can a pneumothorax form?

A

When air is allowed to enter into the pleural space, thus increasing the pressure

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7
Q

What might allow air into the pleural space?

A
  • Damage to the chest wall
  • Damage to the lungs themselves
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8
Q

When does a tension pneumothorax form?

A

When the opening that allows air to enter the pleural space functions as a one-way valve, allowing more air to enter with every breath, but none to escape

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9
Q

What worsens the problem in a tension pneumothorax?

A

The body tries to compensate by increasing the respiratory rate and tidal volume

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10
Q

What is a primary spontaneous pneumothorax?

A

A pneumothorax occuring in healthy people

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11
Q

What is a secondary pneumothorax?

A

A pneumothorax associated with an underlying lung disease, e.g. rupture of congential bulla or cyst in COPD

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12
Q

How does a secondary pneumothorax compare to a primary pneumothorax clinically?

A

The management is potentially more difficult, and the consequences are significantly greater

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13
Q

What is a traumatic pneumothorax?

A

One that occurs after a penetrating chest trauma, such as a stab wound, gunshot injury, or fractured rib

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14
Q

What is an iatrogenic pneumothorax?

A

One following a medical procedure

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15
Q

What medical procedures might cause an iatrogenic pneumothorax?

A
  • Mechnical ventilation
  • Interventional procedures such as central line placement, lung biopsy, or percutaneous liver biopsy
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16
Q

What is a tension pneumothorax?

A

A life-threatening emergency that requires instant action for the severe symptoms and signs of respiratory distres

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17
Q

What are the typical clinical situations where a tension pneumothorax arise?

A
  • Ventilated patients
  • Trauma patients
  • Resuscitation patients
  • Lung disease, especially in acute presentations of asthma and COPD
  • Blocked, clamped, or displaced chest drains
  • Patients receiving non-invasive ventilation
  • Patients undergoing hyperbaric oxygen treatment
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18
Q

What is the risk factors for pneumothorax?

A
  • Smoking
  • Tall stature
  • Endometriosis
  • Underlying lung conditions
  • Family history
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19
Q

Give 6 examples of lung conditions that increase the risk of a pneumothorax

A
  • COPD
  • Tuberculosis
  • Sarcoidosis
  • Cystic fibrosis
  • Malignancy
  • Idiopathic pulmonary fibrosis
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20
Q

How do the symptoms of a primary and secondary pneumothorax compare?

A

Symptoms of a primary pneumothorax may be minimal or absent. In contrast, symptoms are greater in secondary pneumothorax, even if it is relatively smaller in size.

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21
Q

What investigations are performed in pneumothorax?

A
  • Examination
  • Standard erect CXR
  • Ultrasound
  • CT scanning in uncertain or complex cases
  • ABG
22
Q

What examination findings may be seen in pneumothorax?

A
  • Dyspnoea and potentially cyanosis depending on the degree of respiratory inadequacy
  • Tachycardia
  • Hypotension and raised JVP, especially in tension pneumothorax
  • Reduced chest expansion on affected side
  • Trachea devation in tension pneymothorax
  • Hyper-resonance on percussion over the collapse
  • Breath sounds reduced or absent over affected area
23
Q

What does a pulse rate over 135 suggest in pneumothorax?

A

Tension pneumothorax

24
Q

What is pulsus paridoxicus?

A

Abnormally large drop in pulse rate on inspiration

25
Q

What does pulsus paridoxicus suggest in pneumothorax?

A

A severe pneumothorax

26
Q

In what situation in particular might hypotension and raised JVP be present in pneumothorax?

A

Tension pneumothorax

27
Q

What are the differential diagnoses of pneumothorax?

A
  • Pleural effusion
  • Chest pain
  • Pulmonary embolism
28
Q

What does a tension pneumothorax require?

A

Urgent decompression

29
Q

How should a tenson pneumothorax be managed?

A

The patient should be given oxygen, and then a large-bore needle should be inserted into the pleural space through the second or third anterior intercostal space. Following this, a chest drain can be inserted

30
Q

What confirms the diagnosis of tension pneumothorax?

A

A gush of air on decompression

31
Q

Should a tension pneumothorax be decompressed before or after CXR conformation?

A

Before

32
Q

What does the management of a primary pneumothorax depend on?

A

If there is SOB and/or a rim of air of 2cm on CXR

33
Q

How should a primary pneumothorax be managed if there is SOB and/or a rim of air >2cm on CXR?

A

Aspiration should be attempted. If this is not successful, then a chest drain should be inserted

34
Q

How should a primary pneumothorax be managed if there is no SOB, or a rim of air <2cm on CXR?

A

Consider discharge and outpatient review in 2-4 weeks

35
Q

Where is the puncture site in needle aspiration of a pneumothorax?

A

Commonly in 2nd or 3rd intercostal space in the midclavicular line, or in the 4th or 5th intercostal space over the superior rib margin in the anterior axillary line

36
Q

In what respects are needle aspiration and chest-drains the same in management of pneumothorax?

A

There is no significant difference between aspiration and chest drain with regard to immediate success rate, early failure rate, duration of hospitalisation, and one-year success rate

37
Q

What is the advantage of needle aspiration over chest drain in the management of pneumothorax?

A

Needle aspiration is associated with reduction in the proportion of patients hospitalised in comparison with chest drain

38
Q

What are the indications for a chest drain in pneumothorax?

A
  • Any ventilated patient
  • Tension pneumothorax after initial needle relief
  • Persistent or recurrent pneumothorax after simple aspiration
  • Large secondary spontaneous pneumothorax in patients over 50 years
39
Q

What are the most frequent complications of intercostal drainage (chest drain)?

A
  • Pain
  • Intrapleural infection
  • Wound infection
  • Drain dislodgement
  • Drain blockage
40
Q

How should a secondary pneumothorax be managed when there is SOB or a rim of air >2cm on CXR?

A

Chest drain

41
Q

How should a secondary pneumothorax be managed if there is a rim of air 1-2cm on CXR?

A

Attempt aspiration. If unsuccessful, chest drain

42
Q

How should a secondary pneumothorax be managed if the rim of air is under 1cm?

A

Admit for 24 hours for observation and oxygen

43
Q

What is pleurodesis?

A

Obliteration of the pleural space

44
Q

When should pleurodesis be considered in pneumothorax?

A

If there has been a recurrence, or if risk is considered high

45
Q

What is the advantage of surgical pleurodesis?

A

It is more effective

46
Q

What is the disadvantage of medical pleurodesis?

A

It may be more appropriate for patients who are unwilling or unable to undergo surgery

47
Q

How can surgical pleurodesis be performed?

A

Via thoracotomy or thoracoscopy

48
Q

What does surgical pleurodesis involve?

A

Mechanically irritating the parietal pleura, often with a rough pad

Surgical removal of the parietal pleura is also an effective way of achieving stable pleurodesis

49
Q

What does medical pleurodesis involve?

A

The administration of chemicals such as bleomycin, tetracycline, or a slurry of talc into the pleural space through a chest drain. The chemicals cause irritation, and prevents further fluid from accumulating

50
Q

What is required due to the fact that medical pleurodesis is painful?

A

Patients should be premediated with a sedative and analgesics. A local anesthetic can be instilled into the pleural space

51
Q

What are the potential complications of pleurodesis?

A
  • Failure to prevent recurrence
  • Acute respiratory distress
  • Infection of the pleural space
  • Persistent air leak
    Re-expansion of pulmonary oedema

3: MED1 Y3 - Respiratory [18] (15 decks)

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