Condition- Pneumothorax Flashcards
Define pneumothorax
Air in the pleural space (potential space between visceral and parietal pleura)
What are the three main classifications of Pneumothorax?
- Spontaneous: without any trauma or precipitating event
- Primary
- Secondary
- Traumatic: penetrating or blunt injury to the chest
- Tension: intrapleural pressure exceeds atmospheric pressure throughout expiration and often during inspiration
What is the difference between primary and secondary pneumothorax? Give examples of diseases which could lead to it’s development
- Primary: w/o any precipitating event or underlying pulmonary disease
- Secondary: secondary to pulmonary disease e.g. COPD, TB
Give some iatrogenic causes of pneumothorax…
- transcutaneous needle aspiration of lung lesions
- thoracentesis
- endoscopic transbronchial biopsy
- central venous catheter placement
- barotrauma from mechanical ventilation
List some risk factors leading to the development of pneumothorax…
- cigarette smoking
- presence of COPD
- family history
- tall and slender body build (e.g. with Marfan syndrome)
- male sex
- young age
- Recent invasive medical procedure
- Other pulmonary disease: severe asthma, tuberculosis, Pneumocystis jirovecii infection, and cystic fibrosis.
Describe the presentation of someone with a pneumothorax
- Could be ASYMPTOMATIC if small pneumothorax
- SOB
- Chest pain
- Rapid shallow breathing in tension
Describe what signs you might see on examination of someone with pneumothorax…
- Signs of resp distress- low O2 sats, high resp rate, cyanosis
INSPECTION:
- Cyanosis
- Chest drain scar
- Reduced expansion on one side
PALPATION:
- tracheal deviation
- unilateral reduction in lung expansion
PERCUSSION
- Hyper-resonant lungs
AUSCULTATION
- Absent breath sounds on affected area
Describe the signs you might see in someone with a tension pneumothorax…
- Severe resp distress
- Tachycardia
- Hypotension
- Cyanosis
- Distended nexk vain
- Tracheal deviation to contralateral side
- Hyper-resonant percussion
- Reduced air entry and breath sounds on affected side
Which investigations could be ordered for someone with suspected pneumothorax and what would you see?
CXR
- Dark area of film with no vascular markings
- Fluid level see in there’s bleeding
- Don’t need CXR for tension pneumothorax
Why is a tension pneumothorax a medical emergency?
- Have a valve which allows air to be drawn in on inspiration in to the pleural cavity but does not let the air out.
- The mediastinum is pushed over in to the contralateral mediastinum, compressing the great veins.
- Unless air is rapidly removed, cardiorespiratory arrest will occur
How would you manage a patient with tension pneumothorax?
- Maximum O2
- Need decompression: insert 14 gauge catheter ino 2nd ICS MCL on above 3rd rib
- Stop of patent coughs or resistence is felt
- Then insert a chest drain
- Follow up
Describe how you would manage a primary spontaneous pneumothorax (dependent on it size..)
- Small: High Flow O2 and observation
- Large: percutaneous needle aspiration
Describe the management of secondary pneumothoraces and why they’re different to primary ones…
Require HOSPITALISATION because they’re more severe clinically
Higher recurrence rate
- SMALL (<1cm): high conc oxygen + observation (need to be careful with COPD patients)
- MODERATE (1-2cm): Needle aspiration or chest tube
- LARGE (>2cm): Chest tube
How would you manage a patient with recurrent pneumothoraces?
- video-assisted thoracoscopy with stapling of the air leak and pleurodesis
- Chemical Pleurodesis
- surgical pleurectomy
List some of the potential complications of a pneumothorax
- Recurrent pneumothoraces
- Cardio-resp arrest from untreated tension pneumothorax
- re-expansion pulmonary oedema
What percentage of patients who’ve had one pneumothorax will go on to develop another one?
- 30% and 50% of patients will have an ipsilateral recurrent pneumothorax
Lanky Schmidt is a tall, 29 year old male. He has presented to A+E feeling short of breath. He has right sided pleuritic chest pain. He is a non-smoker and otherwise healthy.
A chest radiograph shows a right sided pneumothorax 8mm in diameter.
How should the medical team proceed?
- a)Reassure and Discharge
- b)Observe for 6 hours and give Oxygen
- c)List for elective Surgical Pleurodesis
- d)Needle Aspiration and give Oxygen
- e)Immediate wide bore cannula insertion at 2nd intercostal space
- a)Reassure and Discharge
- b)Observe for 6 hours and give Oxygen
- c)List for elective Surgical Pleurodesis
- d)Needle Aspiration and give Oxygen
- e)Immediate wide bore cannula insertion at 2nd intercostal space
Although pneumothorax is small (<2cm) he is symptomatic (SOB) so you would aspirate inthis occasion
