FN: Pneumothorax

Question 1

Definition

Answer 1

Accumulation of air in the pleural space with secondary lung collapse

Question 2

Classification

Answer 2

Closed
Open
Tension

Question 3

Closed

Answer 3

Intact chest wall and air leaks from lung into pleural cavity

Question 4

Open

Answer 4

Defect in the chest wall allows communication between PTX and exterior: may be sucking

Question 5

Tension

Answer 5

Air enters pleural cavity through a one way valve and cannot escape - mediastinal compression

Question 6

Causes

Answer 6

Spontaneous: primary or secondary
Trauma
Iatrogenic

Question 7

Spontaneous primary

Answer 7

No underlying lung disease –> young, thin men (ruptured subpleural bulla) or smokers

Question 8

Spontaneous secondary

Answer 8

Underlying lung disease

1. COPD
2. Marfans, ehlers danlos
3. Pulmonary fibrosis, sarcoidosis

Question 9

Trauma

Answer 9

Penetrating

Blunt rib fractures

Question 10

Iatrogenic

Answer 10

Subclavian CVP line insertion
Positive pressure ventilation
Transbronchial biopsy
Liver biopsy

Question 11

Presentation symptoms

Answer 11

Sudden onset
Dyspnoea
Pleuritic chest pain
Tension: respiratory distress, cardiac arrest

Question 12

Signs in the chest

Answer 12

Reduced expansion
Resonant percussion
reduced breath sounds
Reduced VR

Question 13

Signs tension

Answer 13

Raised JVP, mediastinal shift, raised HR, reduced BP

Question 14

Signs crepitus

Answer 14

Surgical emphysema

Question 15

Investigations

Answer 15

ABG
US
CXR

Question 16

CXR shows

Answer 16

Translucency + collapse
Mediastinal shift
Surgical emphysema
Cause: rib fractures or pulmonary disease

Question 17

Tension PTX management

Answer 17

1. Resusictate pt.
2. No CXR
3. Large bore Venflon into 2nd ICS, mid-clavicular line
   Insert ICD

Question 18

Traumatic PTX management§

Answer 18

Resuscitate pt.
Analgesia e.g. morphine
3-sided wet dressing if sucking
Insert ICD

Question 19

Spontaneous

Answer 19

Aspirate (>2cm) then ICD