Block 31 Week 5 Flashcards
pneumothorax =
- air in the pleural space
spontanous pneumothorax?
- spontaneous pneumothorax: presence of air in pleural space in absence of trauma or intervention
managemtn options of a pneumothorax?
primary SP?
- no prev pulm disease
- some have emphysema on CT
Secondary spont pneumothorax?
- established chronic lung disease
- 50 yrs or older w smoking history
conservative management of
- if no symptoms, and good lungs - primary spont pneumothorax
- outpatient review every 2-3 days
- CXR to monitor resolution
surgical referral criteria for a pneumothorax
spontaneous secondary pneumothorax?
- conservative management but as inpatient
- CXR to monitor
needle aspiration ?
- mostly for PSP, outcomes for SSP not great
- recommended for people with minimal symptoms
Heimlich valve?
- one way valve
- plastic tube connected to chest wall, air comes through the tube
- plastic collapses when breathing in so air can’t come back in
Ambulatory management of a pneumothorax?
- PSP only
- can go home w this
- more freq follow up due to risk of valve problems
chest drain requires?
- daily inpatient review
- remove drain when resolved
chance of reoccurance of a pneumothorax?
- PSP - 30% chance
- recurrence after surgical intervention is v low
what means that thoracic surgery is required at initial presentation?
- tension pneumothorax
- high risk occupations
prevention/ pleurodesis of pneumothorax?
- during the first ep if patient sig decompensated i.e. COPD
- not for young people with normal lungs bc risk of fibrosis
surgical procedures for a pneumothorax?
- VATS for chemical pleurodesis
- resection of lung parenchyma to stop air leak
advice for a pneumothorax?
- smoking cessation
- can fly 7 days after full resolution
- diving discourgaged permanently
Pleural effusion?
- fluid between the pleura
- cancer, HF, infection
- TB
- PE
bilateral vs unlateral pleural effusion?
- bilateral - usually due to systemic diseases
- unilateral - usually a local cause
pleural effusion history?
- asbestos exposure/ occupational histiry
- medications - tyrosine kinase inhibitirs
Ix for a pleural effusion?
- XR, US, CT
- pleural effusion aspiration
- pleural biopsy
pleural effusion caused by TB?
- pleural fluid high in adenosine deaminase +/- inteferon gamma
- high prevalence area
Pleural biopsy?
- for thickened pleura
- mesothelioma
pleural infection - empyema?
purulent effusion - requires drainage