Lecture 16- Pneumothorax Flashcards
what keeps the lungs inflated
- Balance of the opposing forces is lost
- Outward recoil of chest wall
- Inward recoil of lung
define pneumothorax
- Definition: air within the pleural cavity (a potential space that is made up by the parietal and visceral pleura)*
- Disruption of the pleura–> air flows from higher to lower pressure–> disruption in balance –> lung collapse
classifying pneumothorax
- Simple vs tension
- Primary vs secondary
- Spontaneous vs iatrogenic vs traumatic
Further way of classifying: emergency? Underlying lung disease? Aetiology
Simple
Tiny rim of air within pleural cavity that doesn’t impair haemodynamic stasis
Tension
-
Causes haemodynamic instability
- Hypotensive and tachycardic
- Caused by the one-way flow of air
- More and more air accumulating in pleural cavity
- Life threatening- quick intervention
- Causes e.g. trauma to the chest
Primary
- No underlying lung pathology
- Risk factors
- Male young
- Family history of pneumothorax
- Smoking (x9 risk)
Secondary
*
- Underlying lung pathology
- COPD
- Asthma
- Bronchiectasis – inc CF
- Lung cancer
- Infections: TB, pneumonia
- Marfans syndrome, Ehlers Danlos syndrome
- RA
Spontaneous
Disruption of the subpleural blebs/bulla (air filled sac)
Iatrogenic
*
- Insertion of central/pacing wires
- Esp internal jugular vein
Trauma
- Severe chest wall injury- stab wound or gunshot wound à allows air to enter the pleural space
- Rib fractures –> puncture the visceral pleura
- May not be easily visible
Simple pneumothorax
Presenting symptoms
- Chest pain
- Pleuritic in nature- sharp stabbing
- Sudden onset
- Sharp pain
- +/- SOB
- History of trauma/lung disease
Simple pneumothorax
presenting sign
- Trachea deviation – usually normal, can push the trachea to the other side
- Chest movement reduced on affected side- collapsed lung
- Percussion
- Hyper resonant or resonant on affected side
- Auscultation
- Reduced or absent breath signs on affected side
- Vocal/tactile resonance
- Reduced on affected side
simple pneumothorax radiological findings CXR
- Hyperlucent- appears darker
- Absent lung markings
- Collapsed lung borders seen
simple pneumothorax radiological findings CT scan
- Left lung
- Absent lung markings
- Collapsed lung borders seen
treatment of simple pneumothorax may include
- conservative treatment
- pelural aspiration
- chest drain insertion
conservative treatment of small simple pneumothorax
- Pt goes home
- Comes back to see if resolved
- simple pneumothorax and Pleural aspiration treatment
- Needle in pleural cavity to drain air out
- 2.5l maximum
chest drain insertion in the treatment of simple pneumothorax
- Under ultrasound guidance
- Safe triangle
outline the borders of the safe triangle
Superior: base of the axilla
Inferior: 6th rib/5th intercostal space
Anterior: lateral edge of pectoralis major muscle
Posterior: lateral edge of latissimus dorsi muscle
how does a tension pneumothorax happen
If we do have a tear in the pleura- air will move from higher pressure outside into the lower pressure of the pleural cavity.
- When someone with tension pneumothorax breathes out the air in the pleural cavity is trapped (pleura acts as a valve)
- Build up of air in pleural cavity
- Increased pressure which compresses the SVC/IVC, reducing blood flow to the heart
in a tension pneumothorax the icnreased pressure compresses the
superior and inferior vena cava –> reducing blood flow to the heart
Symptoms of a tension pneumothorax
- Chest pain
- Pleuritic in nature
- Sudden onset
- Sharp pain
- +/- SOB
- History of trauma/liung disease
- Respiratory distress
- Cyanosis
- Tachycardia
- Marked hypoxemia
Signs of a tension pneumothorax
- Low BP
- Tachycardic
- Cyanotic
- Coma
-
Trachea deviation
- Away from the affected side
- Chest movement
- Reduced on affected side
- Auscultation
- Reduced/ absent breath signs
- Will not have time to do percussion
(which would be hyper resonant on affected side)
or vocal/tactile resonance (which would be reduced
on affected side)
treatment of a tension pneumothorax
Emergency needle decompression
outline how you would do an Emergency needle decompression
- First site
- 2nd intercostal space, mid-clavicular line
- Just lateral to the nipple
- If first site doesn’t work
- 5th ICS
- Anterior axillary line, lateral to the nipple
- Remember to go over the rib to avoid the nerve, artery and vein bundle
summary of pneumothorax
