Chapter 68: Pneumothorax Flashcards
most common physical finding in pneumothorax
Sinus tachycardia
tension pneumothorax clinical hallmarks
- tracheal deviation away from the involved side
- hyperresonance of the affected side
- hypotension
- profound dyspnea
size considered as small pneumothorax
< 3 cm
*measurement from the apex of the lung to the cupula of the thoracic cavity on an upright posteroanterior film
Criteria for stable patient with pneumothorax
- Respiratory rate <24 breaths/min
- No dyspnea at rest, speaks in full sentences
- Pulse >60 and <120 beats/min
- Normal blood pressure for patient
- Room air oxygen saturation >90%
- Absence of hemothorax
TRUE or FALSE: First time spontaneous pneumothorax of <20% lung volume in a stable, healthy adult is a scenario where initial oxygen therapy and observation are possible
TRUE
Treatment option: Small-size catheter or small-size chest tube insertion, Heimlich valve, or water seal and admission
Small SECONDARY pneumothorax
immediate ED treatment for tension pneumothorax
Needle decompression (2nd ICS, MCL, just above the rib)
OR
fourth intercostal space just above the rib and at the anterior axillary line
Treatment option: Observation for >3 h on oxygen, repeat chest radiograph, discharge if no symptoms, and return for evaluation if symptoms recur or in 2 wk
Small primary pneumothorax (<20% or 3 cm apex-cupula and asymptomatic)
Treatment option: Moderate-size chest tube and admission; large-size chest tube if fluid or hemothorax present; water seal and admission
Large pneumothorax, either primary or secondary, or bilateral pneumothoraxes
Triangle of safety
- Lateral border of pectoralis major muscle
- Anterior border of latissimus dorsi
- 5th ICS
Reexpansion lung injury is uncommon and seen more often when:
- collapse of the lung for >72 hours
- a large pneumothorax
- rapid reexpansion
- negative pleural pressure suction of >20 cm
