GS - Pneumothorax

Question 1

Explain the signs and symptoms associated with pneumothorax?

Answer 1

Inspection - Use of accessory muscles
Palpation - Decreased expansion on one side
Percussion - Hyper-resonance on one side
Auscultation - Reduced breath sounds on one side and vocal fremitus on same side
Vitals - Raised respiratory rate

Question 2

List the structures through which a chest drain or needle will pass through

Answer 2

Skin
Superficial fascia
Pectoralis major
External intercostal 
Internal intercostal 
Endo thoracic fascia 
Parietal pleura

Question 3

Whats a spontaneous pneumothorax?

Answer 3

Spontaneous pneumothorax (air in the pleural cavity) is commonest in tall thin young males. Air enters the cavity through a defect in the visceral pleura.
Normally the pressure in the pleural cavity is negative (think of vacuum), this is lost with the entry of air and the lung deflates due to the elastic recoil of the lung tissues. Depending on the volume of air in the cavity there may be some shift of the mediastinum. As the pleural defect heals, air is resorbed from the pleural cavity and the situation resolves.

Question 4

If your patient has central cyanosis what does this indicate?

Answer 4

Central cyanosis is associated with an inadequate amount of O2 being in the blood; hence this persons problem is severe and needs treated now

Question 5

What is a raised JVP an indicator of?

Answer 5

A raised JVP indicates there’s more pressure on the right atrium which could indicate a tension pneumothorax

Question 6

Where is thee trachea’s normal position in the neck?

Answer 6

Central

Question 7

Where do you do a needle aspiration for a pneumothorax?

Answer 7

2nd intercostal space mid-clavicular line

Question 8

Whats a tension pneumothorax ?

Answer 8

Tension pneumothorax can occur if there is a valvular arrangement (a flap of pleura) which allows air to enter the pleural cavity on inspiration but will not allow air to escape on expiration (may be associated with traumatic injuries and ‘sucking’ wounds). With each breath, there is an increase in the volume of air in the thorax but with no means of escape the pressure increases. This causes the mediastinum to be shifted towards the unaffected side and reduces venous return. The trachea may also deviate from the midline as the pressure pushes it towards the unaffected side. It is a dangerous condition and the air must be aspirated as an emergency procedure.

Question 9

Whats a Haemothorax?

Answer 9

Blood in the pleural cavity

Question 10

Whats a Chylothorax?

Answer 10

Chyle (lymph) accumulates in the pleural cavity if the thoracic duct has been damaged