Module 10 Pneumothorax and Flail Chest Flashcards
What are three ways gas enters pleura
- From lungs via hole in pleura
- Perforation in chest wall
- Gas forming organisms
Describe the traits of Closed (internal) pneumothorax
- Gas in pleura, not direct contact atmosphere
- no mediastinal shift
- mild, not deadly
Describe traits of open (external) pneumothorax
- Pleura is in direct contact with atmosphere
- opening in chest wall (trauma)
- sucking chest wound
- not fatal
Describe the typical traits of a Tension pneumothorax
Intrapleural pressure exceeds atmospheric pressure.
- Creates a 1 way valve, preventing air from exiting.
- Causes mediastinal shift
- Very fatal, need to act fast.
How does a traumatic pneumothorax happen?
Caused by penetrating or non-penetrating injury
How does a Iatrogenic pneumothorax happen?
Caused by medical treatments, especially transthoracic needle aspiration
What is a spontaneous pneumothorax?
- Traits?
- Risk factors?
- Most Common
- No pre-existing conditions causing.
- Smoking can increase the risk
- seen more in males
What is a primary spontaneous pneumothorax [PSP]?
No underlying disease.
- Seen in young and tall pts.
- peak occurrence in 20-30 years of age.
What is a secondary spontaneous pneumothorax [SSP]?
- Seen in older Pts w/preexisting conditions.
- Peak occurrence greater than 50 years of age.
1 Risk factor in spontaneous pneumos
SMOKING
- 80% of patients have smoking hx
- smoking cannabis increases risk of pneumo even more
other risk factors for spontaneous pneumothoracies
Tall and young
Blebs or bullae from COPD
Signs and symptoms
Acute onset of chest pain
dyspnea
Sometimes no symptoms at all
tachycardia
cyanosis
hyperresonant percussion
diminished breath sounds
JVD
displaced heart sounds.
Treatment for pneumothorax 20% of greater
- Chest tube drainage w/underwater seal suction
- Needle aspiration in 2nd intercostal space.
Tx for recurrent pneumothoracies
Pleurodesis
- Help adhere the visceral and pleural linings together
How many fractures are necessary for a injury to be defined as flail chest?
3 or more double fractures of the rib.
What is pendelluft?
What are 3 ways in works?
Paradoxical chest movement that occurs in the flail segment of the chest. Has the following components:
- On inspiration gas is shunted from into the unaffected lung
- During expiration has moves into affected lung
- Pt rebreathes dead-space gas and hypoventilates
What the Secondary effects of flail chest?
- Chest wall instability
- Lung volume restriction
- Atelectasis
- Pneumothorax
- Pulmonary contusion
- Pneumonia
What are signs/symptoms of flail chest?
bruising and cuts of chest wall
edema
tachycardia
chest pain
cyanosis
respiratory failure
What are CxR findings that would be typical of flail chest?
- SubQ emphysema
- Broken ribs
- Pneumothorax
Tx of mild flail chest?
Analgesics and Routine Bronchial Hygiene
Tx of severe flail chest?
- Mech. ventilation w/PEEP for alveoli stenting.
- Usually for 5-10 days to heal properly.
Where would the placement of a chest tube be in a hemothorax?
At lung bases due to gravity
Placement of chest tube for pneumothorax?
At apices of lung (top peaks)
Tx for a tension pneumothorax?
- Needle aspiration to pop and relieve pressure
- this will help w/the mediastinal shift and the increasing pressures
- Should hear a hissing sound when needle is inserted into the 2nd intercostal space
