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Resp > Lecture 20 - Pneumothorax and pleural effusion > Flashcards

Lecture 20 - Pneumothorax and pleural effusion Flashcards

1
Q

Pneumothorax

A

Presence of air between the visceral and parietal pleura

  1. Chest wall or lung is breached
  2. Loss of pleural seal and communication with atmosphere
  3. Air flows from the atmosphere to the pleural cavity due to negative pressure
  4. Lung collapsed due to unopposed elastic recoil
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2
Q

Primary pneumothorax

A

Spontaneous

Bulla rupture

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3
Q

Secondary pneumothorax

A

Due to underlying disease or trauma

e.g. Lung pathology
Trauma - fractured rib
Penetrating chest injuries

Iatrogenic pneumothorax
Can occur in:
High pressure ventilation
Central line placement

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4
Q

Risk factors form primary pneumothorax

A

Most common in young, tall, thin males

Smoking

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5
Q

Symptoms of pneumothorax

A

Sudden onset pleuritic chest pain

Breathless

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6
Q

Examination of pneumothorax

A

Chest movement: Reduced on affected side

Percussion note: Hyper resonant on affected side - air in cavity

Breath sounds: Vesicular but reduced abscent

Vocal resonance: reduced

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7
Q

Investigation of pneumothorax

A

CXR:

  • Hyperlucent
  • Loss of lung markings
  • Edge of collapsed lung seen

CT:

Increased pleural space

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8
Q

Treatment

A

Small pneumothorax - needle aspiration

Large pneumothorax - Insertion of chest drain

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9
Q

Chest drain placement

A 
5th intercostal space - MAL
In the safe triangle:
- Superior - pec major
- inferior - latissimus dorsi
- inline - nipples

Just above 6th rib to avoid neurovascular bundle

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10
Q

Chest drain

A

Underwater seal as do not want air to re-enter during inspiration

When there are no more bubbles - lung has healed

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11
Q

Tension pneumothorax

A

Pneumothorax causing mediastinal shift and CVS collapse

Air can enter pleural space during inspiration but cannot escape during expiration as flap closes

Intrapleural pressure is higher than atmospheric pressure

  • venous return is impaired and cardiac output drops
  • hypoxemia
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12
Q

Symptoms of tension pneumothorax

A

Fatigue
Severe respiratory distress
Pleuritic chest pain

Tachycardia
Hypotension
Raised JVP

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13
Q

Examination of tension pneumothorax

A

DEVIATED TRACHEA
DISPLACED APEX BEAT

Hyper-resonant
Absent breath sounds

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14
Q

Treatment of tension pneumothorax

A

Emergency needle decompression of chest

In 2nd intercostal space MCL

Then chest drain inserted

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15
Q

Pleural effusion

A

Excess fluid in the pleural cavity

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16
Q

Haemothorax

A

Pleural effusion with blood - trauma

17
Q

Chylothorax

A

Pleural effusion with lymph - leak from lymphatic duct

18
Q

Empyema

A

Pleural effusion with pus

19
Q

Congestive heart failure

A

Increased formation of pleural fluid due to increased pressure in venous end so less fluid reabsorbed

20
Q

Hypoproteinaemia

A

Nephrotic syndrome
Liver failure

  • reduced colloid oncotic pressure
21
Q

Exudate

A

Increased capillary permeability due to inflammation resulting in exudate formation

  • TB
  • Malignancy
  • Pneumonia
22
Q

Transudate

A

Low protein content

Due to increased capillary hydrostatic pressure
- congestive heart failure

Decreased oncotic pressure

  • nephrotic syndrome
  • liver disease
23
Q

Symptoms of pleural effusion

A

Breathlessness

Pleuritic chest pain

24
Q

Examination of pleural effusion

A

Chest movement: Abscent or reduced on affected side

Percussion note: Stony dull

Breath sounds: Vesicular - reduced or abscent

Vocal resonance - reduced

25
Q

Investigation of pleural effusion

A

CXR:

  1. Opacity
  2. Meniscus
  3. Loss of costophrenic angle
  4. Tracheal deviation of very large

CT: confirm pathology

  • fluid in pleural space
  • enlarged mediatinal lymph nodes

Cytology of aspiration

26
Q

Treatment of pleural effusion

A

Treat underlying condition

Chest aspiration

Resp (22 decks)

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