5 Pneumothorax Flashcards
most common cause of secondary spontaneous pneumothorax
COPD
Pneumothorax in AIDS
occurs in 5% of px with AIDS
often from subpleural necrosis secondary to Pneumocystis infection
carries a high mortality
Because of a continued air leak due to necrosis of lung tissue, simple aspiration fails as treatment in this group of patients
remarks on tension pneumothorax
develos as inhaled air accumulates in the pleural space but cannot exit due to a one-way valev system
as intrathoracic pressure increases (>15 to 20 mmHG), venous return and cardiac ang lung function are severely restricted, resulting in hypoxemia and shock
most common physical finding in pneumothorax
sinus tachycardia
remarks on traumatic pneumothorax
in traumatic pneumothorax, the positive predictive value of decresed breath sounds is 86-97% for the diagnosis
clinical hallmarks of tension pneumothorax
- tracheal deviation, contralateral
- hyperresonance
- hypotension
4 profound dyspnea
remarks on bullae
may occur in COPD
follows a single lobe
placing a chest tube into a bulla mistaken for a pneumothroax results in a large pneumothroax, associated bronchopulmonary fistula, and other complications
how to determine large pneumothorax
apex-cupula distance of ≥3 cm
hilar interpleural distance ≥2 cm
criteria for stable patient with pneumothorax
RR <24
No dyspnea at rest, speaks in full sentences
RA SpO2 >90%
Pulse >60 and <120
Normal BP
Absence of hemothorax
O2 administration for small pneumothorax
increases pleural air resorption by creating a nitrogen gas pressure gradient between the alveolus and trapped air
3 lpm via NC to 10lpm via mask
observe for ≥4 hours, and repeat CXR
if symptoms and CXR improve, the patient should return in 1-2 weeks for repeat examination
chest tube sizes
Small-size CT: 10F-14F
Moderate-size: 16F-22F
Large-size CT: 24F-36F
|French sizes represent tube diameter (1 French = 1/3-mm diamter)
when to use small vs moderate vs large-size chest tubes
Small-size chest tubes:
*nontraumatic pneumothoraces
Moderate-size chest tubes:
*large pneumothorax
Large-size chest tubes
*large pneumothorax
*if fluid or hemotrax is present
*Recurrent or bilateral pneumothorax
remarks on chest tube parts
every chest tube has a proximal hole, called the sentinel eye, which is visible radiographically and helps ensure that all drainage holes are inside the pleural cavity
remarks on needle decompression
14-gauge needle is used
if 2nd ICS, do it on the MCL.
If done medial to the MCL, mediastinal vessels can be injured
Triangle of safety
A: lateral border of pectoralis major
P: anterior border of latissimus dorsi
I: 5th ICS
used in pigtail catheter insertion using seldinger technique
Remarkson reexpansion lung injury
Reexpansion lung injury is uncommon and seen more often when there’s:
* collapse of the lung for > 72 hours
* a large pneumothorax
* rapid reexpansion
* or negative pleural pressure suction of >20 cm
Most patients need no treatment for reexpansion injury aside from observation or oxygen, with few adverse outcomes
remarks on iatrogenic pneumothroax
CAUSES
half: transthoracic needle procedures (needle biopsy and thoracentesis)
quarter: subclavian vein catheterization
treatment for iatrogenic pneumothorax is the same as that for spontaneous pneumothorax
air transport with pneumothroax
increased elevation causes an increase in gas volume (Boyle’s law), increasing the risk for tension pneumothorax in air transport of patients with pneumothorax
air medical experts recomend no high-altitude flying for at least 7-14 days after pneumothorax resolution
diving and pneumothorax
a history of spontaneous pneumothorax is a contraindication to underwater diving unless treated by surgical pleurectomy and normal lung function exists
disposition for pneumothorax
Discharge patients with
- primary spontaneous pneumothorax…
- successfully treated with observation or with catheter aspiration…
- if the pneumothorax does not increase in size over 3-6 hours …
- and symptoms resolve or do not worsen
**observe for longer or admit* the remaining patients
Complications of pneumothorax
Hypoxia
Hypercapnia
Hypotension
Other intervention complications in pneumothorax
Intercostal vessel hemorrhage
Lung parenchymal injury
Empyema
Tube malfunction (development of an air lwak or tension pneumothorax)
