Acute - Pneumothorax Flashcards
List 5 risk factors for a pneumothorax.
pre-existing lung disease: COPD, asthma, cystic fibrosis, lung cancer, Pneumocystis pneumonia
connective tissue disease: Marfan’s syndrome, rheumatoid arthritis
smoking, cannabis
ventilation, including non-invasive ventilation
catamenial pneumothorax is the cause of 3-6% of spontaneous pneumothoraces occurring in menstruating women. It is thought to be caused by endometriosis within the thorax
What are the signs/symptoms of pneumothorax?
Sudden onset of:
- SOB
- Chest pain - often pleuritic
- Sweating
- Tachypnoea
- Tachycardia
What are the causes of pneumothorax?
- Spontaneous
- Trauma
- Iatrogenic - mechanical ventilation, lung biopsy, central line insertion
- Secondary - background of respiratory disease e.g. asthma, COPD, infection
How would you approach someone with suspected pneumothorax?
- A-E assessment and correct any abnormalities e.g. oxygen if SpO2<94%
- Hx for risk factors
- Erect CXR - no lung markings, edge of the lung visible, size of pneumothorax is measured horizontally from the edge of the lung to inside of the chest wall at the level of the hilum
What are the signs of pneumothorax?
Reduced expansion
Hyperresonance to percussion and diminished breath sounds on affected side
How is a primary pneumothorax managed?
- If the rim of air is <2cm and the patient is not SOB, then discharge should be considered, follow up CXR in 2-4 weeks to ensure it has resolved
- If the rim of air is >2cm or the patient is SOB, then aspiration
- If aspiration fails twice, then chest drain
How is a secondary pneumothorax managed?
- If the rim of air is 1-2cm, then aspirate
- If the rim of air is >2cm or SOB, then chest drain
How is iatrogenic pneumothorax managed?
- less likelihood of recurrence than spontaneous pneumothorax, majority will resolve with observation, if treatment is required then aspiration should be used
- ventilated patients need chest drains, as may some patients with COPD - risk of converting to tension pneumothorax
Which investigation can be used to accurately assess the exact size of a pneumothorax?
CT chest
State 3 circumstances in which a chest drain is required for the management of pneumothorax?
- Unstable
- Bilateral pneumothorax
- Secondary pneumothorax and >2cm
Where is a chest drain inserted and why?
Triangle of safety - minimises chances of damage to local structures
5th ICS
mid-axillary line - lateral edge of lattisimus dorsi
anterior axillary line - lateral edge of pectoralis major
(CXR to confirm position once chest drain is inserted)
What advice should be given to someone recovering from a pneumothorax?
- patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men
- regarding scuba diving, the BTS guidelines state: ‘Diving should be permanently avoided unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively.’
