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Respiratory Unit > 9.2 - Pneumothorax And Pleural Effusion > Flashcards

9.2 - Pneumothorax And Pleural Effusion Flashcards

1
Q

What is a pneumothorax?

A

Air within the pleural cavity

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2
Q

What complications can be caused by a pneumothorax?

A

Disruption of the pleura (visceral or pleural) -> air flows from higher pressure to lower pressure -> disruption of the balance -> lung collapses.

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3
Q

What is a simple pneumothorax?

A

Small to moderate size

Haemodynamic stable patient

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4
Q

What is a tension pneumothorax?

A

Causes haemodynamic instability (tachycardic, hypertensive)

Caused by the one-way flow of air into the pleural cavity causing increase of pressure in the thoracic cavity

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5
Q

What is a primary pneumothorax?

A

Spontaneous

No underlying lung pathology

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6
Q

What are the risk factors for a primary pneumothorax?

A

Male
Young
Family history of pneumothorax
Smoking

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7
Q

What is secondary pneumothorax?

A

Pneumothorax secondary to pre existing lung pathology

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8
Q

What lung pathologies are associated with secondary pneumothorax?

A 
COPD (70%)
Asthma
Bronchiectasis – inc cystic fibrosis
Lung cancer
Infections : TB, pneumonia
Marfan’s syndrome, Ehler’s Danlos syndrome 
RA, SLE (systemic lupus erythematosus)
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9
Q

What are the 3 aetiologies of a pneumothorax?

A

Spontaneous - sub plural bless / bulla (air-filled sacs) burst

Iatrogenic - insertion of central lines (esp to internal JV) / cardiac pacing wires

Trauma - stab wound/ gunshot wound/ rib fracture puncturing visceral pleura

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10
Q

What are the presenting symptoms of a simple pneumothorax?

A

Chest pain - pleuritic in nature, sudden onset, sharp pain
SOB
History of trauma/lung disease

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11
Q

What are the clinical signs of a simple pneumothorax?

A

Trachea deviation- Normal
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

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12
Q

How does a simple pneumothorax present of a CRX?

A

Hyper-lucent (ie appear darker)
Absent lung markings
Collapsed lung borders seen

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13
Q

How does a CT of a simple pneumothorax appear?

A

Absent lung markings

Collapsed lung borders seen

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14
Q

What are the 3 ways of managing pneumothorax?

A

Conservative treatment
Pleural aspiration
Chest drain

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15
Q

When is conservative treatment for a pneumothorax adequate?

A

Small pneumothorax
Send home, bring back at later date
See if symptoms resolved and Xray improved

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16
Q

What is pleural aspiration the correct treatment of a pneumothorax?

A

Maximum amount you can drain = 2.5L

17
Q

How is a chest drain inserted

A

By ultrasound guidance

18
Q

Where is a chest drain inserted?

A

Safe triangle borders:
Superior: Base of the axilla
Inferior: 6th rib / 5th intercostal space
Anterior: lateral edge of pectoralis major muscle
Posterior: lateral edge of latissimus dorsi muscle

19
Q

Where does a chest drain drain into?

A

Underwater seal - allows air to leave pleural cavity but not re-enter.

20
Q

Why does air move into the pleural space?

A

As external air pressure is higher than in the pleural cavity

21
Q

Why is a tension pneumothorax a medical emergency?

A

As build up of pressure in the thoracic cavity compresses the SVC/IVC.
Blood supply in heart interrupted. Can cause hypotension, tachycardia, cyanosis, and hypoxaemia.
Can lead to cardiac arrest and death

22
Q

What are the presenting signs and symptoms of a tension pneumothorax?

A 
Similar to simple pneumothorax but also have: 
Respiratory distress
Cyanosis
Marked tachycardia
Hypoxemia
23
Q

What are the clinical signs of a tension pneumothorax?

A

Trachea deviation - Away from the affected side
Chest movement - Reduced on affected side
Auscultation - reduced/absent on affected side
Percussion - hyper resonant or resonant on affected side
Vocal/tactile resonance -reduced on affected side

24
Q

How do we treat tension pneumothorax?

A

Emergency needle decompression - needle in pleasurable cavity in the 2nd intercostal space in the mid-clavicular line

25
Q

What is a pleural effusion?

A

Excess fluid in the pleural cavity - imbalance between rate of production of pleural fluid from systemic capillaries and absorption into the lymphatic system

26
Q

What are the 4 main types of pleural effusion?

A

Simple Effusion: When the fluid is pleural fluid – can be transudate or exudate
Haemothorax: When the fluid is blood (e.g. trauma)
Chylothorax: When the fluid is lymph (e.g. leak from lymphatic duct)
Empyema: When the fluid is pus (secondary to resistant infection)

27
Q

What are the presenting symptoms of pleural effusion?

A

SOB - gradual onset
Exercise intolerance
Pleuritic chest pain
Features of underlying clinical disease such as breathlessness, peripheral/pulmonary oedema - congestive cardiac failure, lung malignancy

28
Q

What are the clinical signs of pleural effusion

A

Trachea Deviation - Away from affected side if large
Chest movement - Reduced on affected side
Percussion note - “Stony” dull on affected side due to fluid not transmitting sound waves
Breath sounds - (Vesicular) reduced /absent on affected
side
Vocal Resonance - Reduced on affected side

29
Q

What are the causes of pleural effusion?

A

Trauma - heamothorax and chylothorax

Infective cause - empyema

30
Q

How do we investigate a pleural effusion?

A 
CXR
Ultra sound guided pleural aspiration 
Send fluids off for:
Protein levels
Glucose levels
LDH (lactate dehydrogenase
MC&S (microscopy, culture and sensitivity)
PH
31
Q

If the pH of the fluid effusion is low what does this indicate?

A

Empyema - indicative of pus

32
Q

How do we differentiate transudate vs exudate?

A

Light’s criteria - based on protein and LDH levels
Comparison between the effusion fluid and blood values.
If there is a lot of protein, this is an exudate.

33
Q

What are the main causes of transudate simple pleural effusion?

A

Congestive Cardiac Failure
Hypoproteinaemia
• Nephrotic syndrome
• Liver cirrhosis

34
Q

What are the main causes of an exudate simple pleural effusion

A

Infection (TB, pneumonia) Lung malignancy Pulmonary infarction

35
Q

How do we treat pleural effusion?

A

Chest aspiration
Recurrent effusions (malignant cause) =
Indwelling pleural catheter (IPC) for intermittent drainage
Pleurodesis: Obliteration of the pleural space

Respiratory Unit (12 decks)

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