Pneumothoax Flashcards
Classification of pneumothorax?
Spontaneous - primary (no underlying lung disease) or secondary (COPD, asthma, CF, lung cancer, PCP, marfans)
Traumatic - Penetrating or blunt chest trauma
Iatrogenic (thoracentesis, central venous catheter, NIV, biopsy)
Tension pneumothorax - displacement of mediastinum
Catamenial pneumothorax
Clinical features of pneumothorax?
Dyspnoea,
Pleuritic chest pain
Hyper-resonant percussion,
Reduced breath sounds,
Reduced lung expansion,
Tachypnoea,
Tachycardia
If tension - resp distress, tracheal deviation, hypotension
What is the first step in managing a pneumothoraz?
Determine if patient is symptomatic:
If none or minimal - conservative care regardless of pneumothorax size.
Symptomatic - assess for high risk characteristics
What are the high risk characteristics for pneumothorax
Haemodynamic compromise
Significant hypoxia,
Bilateral pneumothorax,
Underlying lung disease,> 50 years with significant smoking history,
Haemothorax
What is the management of a symptomatic pneumothorax?
If no high-risk factors and it is safe to intervene: Chose between conservative care (often if <2cm), ambulatory care (if pt wants to avoid inpatient care), needle aspiration (generally if >2cm laterally/apically or any size on CT then safe to intervene)
If high risk features present: Chest drain
What is the conservative care for pneumothorax?
Primary spontaneous pneumothorax - review every 2-4 days as an OP.
Secondary pneumothorax - monitored as an in patient.
If stable then review as OP in 2-4 weeks.
What is the ambulatory care for pneumothorax?
Eg, Rocketu pleural vent - One way valve and vent to prevent air/fluid return into pleural space while allowing air to escape.
Management of recurrent/persistent pneumothorax?
Video-assisted thoracoscopic surgery (VATS) should be considered for mechanical/chemical pleurodesis +/- bullectomy.
Two key complications of chest drains?
Air leak around drain site
Surgical emphysema
