9.1 & 9.2 Pneumothorax Flashcards
Primary vs secondary vs iatrogenic pneumothorax
Primary: Absence of existing lung pathology
Secondary: Existing lung pathology
Iatrogenic: Pneumothorax secondary to invasive procedure or surgery
What is a tension pneumothorax? List one way if can occur
- Accumulation of air in pleural space, displacing other mediastinal structures
- Example: this can occur in traumatic injury if a flap of tissue create a one-way valve, causing air enter and stay in the pleura
What is a simple, generalised definition of pneumothorax?
Air in pleural space (pneumatic tires: full of air)
What classification of pnuemothorax do primary and secondary fall under?
Sponatenous (unless specified tension)
What classification of pneumothorax does iatrogenic pneumothorax fall under?
Traumatic
In what age group is primary/secondary pneumothorax most common?
Primary: 15-34
Secondary: >55
Is pneumothorax more common in men or women?
Men
List some risk factors for pneumothorax
- Smoking
- Sub-pleural blebs
- Underlying lung disease
Presenting symptoms of a patient with suspected pneumothorax. What is the intensity of these symptoms?
- Dyspnoea (often acute onset)
- Chest pain (often pleuritic)
- Intensity is highly variable!
Differential diagnoses other than pneumothorax for same symptoms
- Pulmonary embolism
- Pleuritis
- Acute coronary syndrome
- Pericarditis
- Musculoskeletal inflammation
Will physical exam always be abnormal in pneumothorax patients?
- No
- It can sometimes be normal
Which side does the trachea deviate to during pneumothorax?
Opposite side to pneumothorax
How is chest expansion changed during pneumothorax?
Reduced on ipsilateral side
Percussion note during pneumothorax
Hyper-resonant
Invesitgations for a patient with suspected pneumothorax
- Observations (RR, HR, BP, SpO2)
- Blood tests (for other differentials): CRP, WCC, troponins, d-dimer
- ECG
- CXR
- Maybe CT Chest
Risk factors for tension pneumothorax
- Trauma
- Positive pressure/mechanical ventilation
- CPR
Symptoms and signs of tension pneumothorax in sponatenously breathing (i.e. self-breathing) patients
- Dyspnoea
- Chest pain
- Tachypnoea
- Tachycardia
- Hypoxaemia
- Signs of pneumothorax
Is tension pneumothorax a clinical or radiological diagnosis?
- Clinical
- It cannot be diagnosed with radiology; this is merely suggestive
What step always comes first in pneumothorax management
- Resuscitation
- Airway stabilisation
Treatment recommendations for primary spontaneous pneumothorax in haemodynamically stable patient
- Observation
- Monitoring
Treatment recommendations for primary spontaneous pneumothorax in NOT haemodynamically stable patient
- Tube thoracostomy (remove substances from pleura)
- Drainage to under-water sealed drain
What is the estimated rate of recurrence of pneumothorax following 1st PSP?
- Up to 30%
- Most likely to occur in first month to year
What is the estimated rate of recurrence of pneumothorax following 2nd PSP?
- 60-70%
Risk factors for pneumothorax recurrence
- Female
- Tall stature
- Low BMI
- Smoking
- Large initial pneumothorax
