9. Pneumothorax Flashcards
What is a pneumothorax?
Air within the pleural cavity
Disruption of the pleura, air flows from higher pressure to lower pressure, disruption of the balance, lung collapses
What are the different ways of classifying pneumothorax?
Simple vs tension pneumothorax
Primary vs secondary pneumothorax
Spontaneous vs iatrogenic vs traumatic pneumothorax
What is the difference between simple and tension pneumothorax?
Simple gives haemodynamic stable patients
Tension causes haemodynamic instability caused by one way flow of air
What is the difference between primary and secondary pneumothorax?
Primary have no underlying lung pathology
Secondary have underlying lung pathology
What are the risk factors for primary pneumothorax?
Male
Young
Family history
Smoking
What underlying lung pathology can cause secondary pneumothorax?
COPD Asthma Bronchiectasis Lung cancer Infections - TB, pneumonia Marfan’s syndrome, Ehlers danlos syndrome RA
What can cause spontaneous pneumothorax?
Usually due to subpleural blebs/bulla (air filled sac)
What can cause iatrogenic pneumothorax?
Insertion of central lines/pacing
What can cause trauma pneumothorax?
Severe chest wall injury (stab wound, gunshot wound)
Rib fractures - puncture visceral pleura
What are the symptoms of simple pneumothorax?
Chest pain - pleuritic, sudden onset, sharp pain
SOB
History of trauma/lung disease
Wha are the signs of simple pneumothorax?
Trachea deviation
Chest movement - reduced on affected side
Percussion - hyper-resonant or resonant on affected side
Auscultation - reduced/absent on affected side
Vocal/tactile resonance - reduced on affected side
What does a simple pneumothorax look like on CXR?
Hyper-lucent (appear darker)
Absent lung markings
Collapsed lung borders seen
How are simple pneumothorax treated?
- Conservative
- Pleural aspiration
- Chest drain
How is a chest drain inserted?
Ultrasound guided
Safe triangle
- superior: base of axilla
- inferior: 6th rub/5th intercostal space
- anterior: lateral edge of pectoral is major muscle
- posterior: lateral edge of latissimus dorsi muscle
What are the symptoms of tension pneumothorax?
Chest pain - pleuritic, sudden onset, sharp pain
SOB
History of trauma/lung disease
