Cardio: Pneumothorax Flashcards
what are the 2 kinds of pneumothorax?
primary (no known cause to this) and secondary (brought on by pre-existing pulmonary disease)
symptoms of pneumothorax
- shortness of breath
- pleuritic chest pain (pain is caused when the surfaces rub against each other)
- change in voice (becomes more nasal)
- sudden-onset
signs of pneumothorax
- hyper resonance
- dull in auscultation
- reduced air entry
- absent breath sounds
- absent fremitus
radiological signs of pneumothorax
- tracheal deviation in tension pneumothorax
- edge of the collapsed lung
what happens with the trapped air in the pleura?
the pressure of that air causes pressure on the surrounding structures, like the atrium and pulmonary arteries, causing inflow obstruction which causes a lack of venous return. as the pressure builds up further, it can collapse the left ventricle and the aorta, causing outflow obstruction, which is lethal
what is surgical emphysema?
when air is trapped in the soft tissues
where can air accumulate in surgical emphysema?
face, neck and vocal cords, causing a nasal voice
how to distinguish between skin folds and lung markings?
skin folds cross the edge of the chest wall whilst lung markings don’t
treatment of pneumothorax
- needle aspiration
- chest drain
how would you do a needle aspiration?
- done in a tension pneumothorax
- 2nd intercostal space at MCL
- 90 degrees to the skin
how would you do a Seldinger drain?
- Pass a wire into the desired anatomical space and pass the catheter/drain over the wire
- There, you know you are in the correct anatomical space - railroading
- Go in the safety triangle
- Feel a rib
- Pass a needle connect to syringe with anaesthetic - aspirate and inject loppju
- See air in the anaesthetic
- Then, remove the syringe, leaving the needle
- Through needle, pass wire with a curved end
- Pass wire in and leave 10cm out
- Take needle out
- Then, pass a dilator (pen thing) over the needle and pass in and out - this dilates a tract over the drain
- Then pass the drain over the wire
- Remove the wire and connect to an underwater seal
what type of haemodynamic compromise does a pneumothorax cause?
- impeding blood flow through a great vessel
- you can lose a lot of blood through a haemothorax, which can cause shock and death
primary survery of trauma
ATOM-FC
- airway obstruction
- tension pneumothorax
- open chest wound/pneumothorax
- massive haemothorax
- flail chest
- cardiac tamponade
management of a sucking chest wound
- dressing on 4 sides, leaving one corner open
what can happen in a sucking chest wound?
air would go into the wound, without being able to come out, causing a tension pneumothorax
