6. Pneumothorax Flashcards
classify primary and secondary pneumothorax
primary- no underlying oathology, due to future of sub pleural air bleb
secondary- there is e.g. COPD, asthma, pulmonary fibrosis
aetiology of simple spontaneous primary pneumothorax
- small tear in visceral pleura
- air leaks into pleural space when breathing in
- pleura seals itself due to elastic recoil
- air in pleural space reabsorbed
AIR MOVES IN AND OUT SO REACHES EQUILIBRIUM OF PRESSURES
treatment of pneumothorax with no breathlessness, <2cm
nothing, discharge and follow up in 2/3 weeks with CXR
aetiology of simple spontaneous secondary pneumothorax
- underlying lung pathology punctures pleura e.g. bleb/bullae rupture
- less elastic recoil so more air in pleural space
- puncture seals itself eventually once pressures equilibrate
treatment of spontaneous simple secondary pneumothorax
-needle aspiration up to 2.5 L
-high flow O2 and observe 24 hours
(aim for 88-92% if they’re a COPD retainer)
-chest drain maybe is seal reopens
describe how a needle aspiration works
small amount of water in syringe, push through chest wall until air bubbles
NEED A VALVE or water will enter pleural space
borders of anatomical safe triangle
superior: axilla
medial: pec major lateral edge
lateral: lat dorsi lateral edge
inferior: 5th ICS
treatment of simple iatrogenic pneumothorax
chest drain
describe how a water sealed chest drain works
insert into safe triangle, tube in pleural cavity
free end submerged in water
=one way valve
swinging (pressure changing) and bubbling (air leaving) means its working
how do you know a chest drain is working?
swinging (pressure changing) and bubbling (air leaving) means its working
in tension pneumothorax, why might the chest dip on inspiration?
paradoxical breathing- occurs when multiple ribs fractured
do you CXR in suspected tension pneumothorax?
NO
patient would be dead before you could treat
emergency needle decompression
how does a tension pneumothorax develop?
damaged pleura creates a one way valve, air in but NOT out
increased intra thoracic pressure
each breath fills pleural space more, so no eqm can be reached
compresses mediastinal structures,= haemodynamic compromise as heart can’t pump
immediate treatment of tension pneumothorax
emergency needle decompression
where to do emergency needle decompression
2nd ICS mid clavicular line
