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Respiratory System DO > Pleural Disease - Pneumothorax > Flashcards

Pleural Disease - Pneumothorax Flashcards

1
Q

What is a pneumothorax

A

The presence of air within the pleural cavity

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2
Q

What causes a pneumothorax

A

A breach of the visceral or parietal pleura with the entry of air causing the lung to collapse away from the chest wall because of the elastic recoil of the lung

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3
Q

What are the two ways pneumothorax can come about

A

Spontaneously

Traumatically

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4
Q

What types of spontaneous pneumothorax are there

A

Primary spontaneous

Secondary spontaneous

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5
Q

What types of traumatic pneumothorax are there

A

Non-iatrogenic

Iatrogenic

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6
Q

What is a tension pneumothorax

A

The build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space

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7
Q

Is primary spontaneous pneumothorax a clinically apparent disease

A

No

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8
Q

Who does primary spontaneous pneumothorax tend to affect

A

Tall thin individuals

People under age of 45 (accounts for 81% of pneumothorax)

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9
Q

What is the cause of primary spontaneous pneumothorax

A

It is believed to be due to the weight of the lung which induces the development of apical blebs that rupture

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10
Q

How many men and women suffer from primary spontaneous pneumothorax

A

18-28 per 100,000 men per year

1.2-6 per 100,000 women per year

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11
Q

What is the peak incidence of primary spontaneous pneumothorax

A

It has a young peak incidence (20-30 years)

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12
Q

What is the cause of secondary spontaneous pneumothorax

A

Tends to occur due to a pre-existing lung disease (almost any lung disease)

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13
Q

What types of pre-existing lung diseases can cause secondary spontaneous pneumothorax

A 
COPD
Asthma
Pneumonia
TB 
Cystic fibrosis
Fibrosing alveolitis
Sarcoidosis
Histiocytosis X
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14
Q

How many cases of secondary spontaneous pneumothorax are due to COPD

A

30-50%

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15
Q

How many asthmatics get secondary spontaneous pneumothorax

A

0.8%

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16
Q

How many TB patients get secondary spontaneous pneumothorax

A

1.4%

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17
Q

Name 2 causes of traumatic non-iatrogenic pneumothorax

A

Penetrating chest injury (stab, gunshot)

Blunt chest injury (rib fractures, bronchial rupture)

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18
Q

Name 4 causes of traumatic iatrogenic pneumothorax

A

Pleural aspiration/biopsy
Sub-clavian vein cannulation
Lung, liver, breast, renal biopsy
Acupuncture

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19
Q

What are the symptoms are of a pneumothorax

A

Small pneumothorax in a patient with a good respiratory reserve is normally asymptomatic

Acute breathlessness, worsening breathlessness and pleuritic chest can occur

20
Q

What does extreme dyspnoea in a previously fit individual indicate

A

Tension pneumothorax

21
Q

What does extreme dyspnoea in a person with chest disease indicate

A

Tension pneumothorax or severe lung disease

22
Q

What are the signs of of a small pneumothorax

A

Normally no signs

23
Q

What are the signs of a non-tension pneumothorax

A

Decreased expansion
Hyper resonant
Absent or decreased breath sounds

24
Q

What are the signs of a tension pneumothorax

A

Trachea deviates away from the affected side
Haemodynamic compromise
Increased JVP

25
Q

What type of investigation can be conducted for a pneumothorax

A

Chest X-Ray

26
Q

What is considered a large or small pneumothorax

A

Large - over 2cm

Small - under 2cm

27
Q

What are the 4 questions which should be asked when deciding treatment

A

1) Is it a tension pneumothorax?
2) Is the pneumothorax small or large?
3) Is the patient breathless?
4) Is the pneumothorax likely to be primary or secondary?

28
Q

How is a tension pneumothorax treated

A

Cannula (large grey venflon) in the 2nd intercostal space min-clavicular line then insert an intercostal chest drain

29
Q

How is a small primary pneumothorax (non-breathless) treated

A

Observed overnight
Repeat chest X-Ray
If no change then hole has sealed
Discharged

30
Q

What should the patient be advised

A

Avoid vigorous activity

Return if they become breathless

31
Q

How does a small primary pneumothorax resolve

A

1.25% per day

Should be reviewed in a chest X-Ray clinic 2 weeks

32
Q

How is a breathless primary pneumothorax treated

A

Aspiration while the patient is at at 45˚ and lignocaine placed into the second intercostal space in the midclavicular line using a 50 ml syringe, venflon, 3 way tap and tube to water

33
Q

How long is a breathless primary pneumothorax treated

A

Aspirated until the surface of the lung can be felt on the tip of the venflon just beneath the surface of the chest wall

34
Q

What does it mean is over 3L is aspirated

A

Persistent air leak

35
Q

If the aspiration is successful in a breathless primary pneumothorax what are the next steps

A

A chest X-Ray should be conducted after 24 hours

36
Q

If the aspiration is unsuccessful in a breathless primary pneumothorax what are the next steps

A

Chest drain

37
Q

Can a small breathless secondary pneumothorax be aspirated

A

Yes but it is less successful

38
Q

What is the recommended treatment for breathless secondary pneumothorax

A

An intercostal chest drain should be inserted into the 4th intercostal space in the mid-axillary line using a small bore 10-14F

39
Q

What three things should occur upon the successful insertion of an intercostal chest drain

A

Lungs should inflate within 1-2 days
Drain should stop bubbling
CXR should confirm that the lung has inflated

40
Q

After inserting an intercostal chest drain what are the two next steps available

A

The drain can be clamped for 24 hours, repeat CXR done, if there is no change then the drain can be removed
A repeat CXR can be conducted after 24 hours and if there is no change then the drain can be removes

41
Q

Why is clamping the intercostal chest drain for 24 hours a better choice

A

Allows the detection of small air leaks and avoids the re-insertion of chest drains

42
Q

If the lungs fail to re-inflate and the drain continues to bubble 48 hours after inserting an intercostal chest drain what should be done

A

A suction should be applied to the drain (high volume, low pressure -10 to -20 cm H2O)

43
Q

What should be done if the lungs still fail to re-inflate after applying suction

A

Thoracic surgeons should be contacted at 3 days for a thoracoscopic inspection of the visceral pleura, identification of blebs, tears, clipping and talc poudrage pleurodesis

44
Q

What is the risk of a subsequent pneumothorax

A

High risk
54% recurrence within 4 years
10-25% in first 4 months
10-15% contralateral pneumothorax

45
Q

Which 4 categories of patients should be referred for a surgical pleurodesis

A

Second ipsilateral pneumothorax
First contralateral pneumothorax
Bilateral spontaneous pneumothoraxes
First pneumothorax in high risk professions (pilots, divers)

46
Q

What other types of management are there

A

Talc poudrage

Pleurectomy

Respiratory System DO (33 decks)

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