Module 10 Pneumothorax and Flail Chest

Question 1

What are three ways gas enters pleura

Answer 1

1. From lungs via hole in pleura
2. Perforation in chest wall
3. Gas forming organisms

Question 2

Describe the traits of Closed (internal) pneumothorax

Answer 2

• Gas in pleura, not direct contact atmosphere
• no mediastinal shift
• mild, not deadly

Question 3

Describe traits of open (external) pneumothorax

Answer 3

• Pleura is in direct contact with atmosphere
• opening in chest wall (trauma)
• sucking chest wound
• not fatal

Question 4

Describe the typical traits of a Tension pneumothorax

Answer 4

Intrapleural pressure exceeds atmospheric pressure.

• Creates a 1 way valve, preventing air from exiting.
• Causes mediastinal shift
• Very fatal, need to act fast.

Question 5

How does a traumatic pneumothorax happen?

Answer 5

Caused by penetrating or non-penetrating injury

Question 6

How does a Iatrogenic pneumothorax happen?

Answer 6

Caused by medical treatments, especially transthoracic needle aspiration

Question 7

What is a spontaneous pneumothorax?
- Traits?
- Risk factors?

Answer 7

• Most Common
• No pre-existing conditions causing.
• Smoking can increase the risk
• seen more in males

Question 8

What is a primary spontaneous pneumothorax [PSP]?

Answer 8

No underlying disease.

• Seen in young and tall pts.
• peak occurrence in 20-30 years of age.

Question 9

What is a secondary spontaneous pneumothorax [SSP]?

Answer 9

• Seen in older Pts w/preexisting conditions.
• Peak occurrence greater than 50 years of age.

Question 10

1 Risk factor in spontaneous pneumos

Answer 10

SMOKING

• 80% of patients have smoking hx
• smoking cannabis increases risk of pneumo even more

Question 11

other risk factors for spontaneous pneumothoracies

Answer 11

Tall and young

Blebs or bullae from COPD

Question 12

Signs and symptoms

Answer 12

Acute onset of chest pain
dyspnea
Sometimes no symptoms at all
tachycardia
cyanosis
hyperresonant percussion
diminished breath sounds
JVD
displaced heart sounds.

Question 13

Treatment for pneumothorax 20% of greater

Answer 13

1. Chest tube drainage w/underwater seal suction
2. Needle aspiration in 2nd intercostal space.

Question 14

Tx for recurrent pneumothoracies

Answer 14

Pleurodesis

• Help adhere the visceral and pleural linings together

Question 15

How many fractures are necessary for a injury to be defined as flail chest?

Answer 15

3 or more double fractures of the rib.

Question 16

What is pendelluft?

What are 3 ways in works?

Answer 16

Paradoxical chest movement that occurs in the flail segment of the chest. Has the following components:

1. On inspiration gas is shunted from into the unaffected lung
2. During expiration has moves into affected lung
3. Pt rebreathes dead-space gas and hypoventilates

Question 17

What the Secondary effects of flail chest?

Answer 17

1. Chest wall instability
2. Lung volume restriction
3. Atelectasis
4. Pneumothorax
5. Pulmonary contusion
6. Pneumonia

Question 18

What are signs/symptoms of flail chest?

Answer 18

bruising and cuts of chest wall
edema
tachycardia
chest pain
cyanosis
respiratory failure

Question 19

What are CxR findings that would be typical of flail chest?

Answer 19

1. SubQ emphysema
2. Broken ribs
3. Pneumothorax

Question 20

Tx of mild flail chest?

Answer 20

Analgesics and Routine Bronchial Hygiene

Question 21

Tx of severe flail chest?

Answer 21

1. Mech. ventilation w/PEEP for alveoli stenting.
2. Usually for 5-10 days to heal properly.

Question 22

Where would the placement of a chest tube be in a hemothorax?

Answer 22

At lung bases due to gravity

Question 23

Placement of chest tube for pneumothorax?

Answer 23

At apices of lung (top peaks)

Question 24

Tx for a tension pneumothorax?

Answer 24

1. 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