Pneumothoraces Flashcards
Define Pneumothorax
Air in the pleural space leading to impaired oxygenation and ventilation
List 7 indications of an intercostal chest drain.
- Tension Pneumothorax
- Primary Pneumothorax with failed aspiration
- Secondary Pneumothorax symptomatic in a patient >50 years old
- Presence of blood, water or pus
- Traumatic Pneumothorax
- Mechanically ventilated patients with a Pneumothorax
- Bilateral pneumothoraces
List 2 indications of aspiration of a Pneumothorax
- Primary Pneumothorax that do not qualify for observation or intercostal chest drain
- Secondary Pneumothorax that are small and asymptomatic in patients less than 50 years old
Should aspiration of pneumothoraces be done under any anaesthetics?
Yes, local anesthetic
When do you repeat a CXR after an aspiration of a Pneumothorax?
6 hours later. This is also the perfect time to do a second aspiration
Which patients with a Pneumothorax deserves observation and when to let them go home?
The ones who do not qualify for either aspiration or intercostal chest drain
When to discharge: If no expansion and patient has no symptoms and they are able to return to the hospital, they can be discharged.
For how long to patient with a Pneumothorax need to be observed for?
6 hours when placed on oxygen
This is done if the pneumothorax is small and the patient is not symptomatic
When is a repeat CXR done in a patient with a Pneumothorax who only qualifies for observation?
After 12 hours.
First 6 hours for observation on Oxygen then after 6 hours a repeat CXR is done
Should patients who receive an aspiration of Pneumothorax be admitted?
the patient must still be admitted for 24hrs on high-flow O2
State why it is not ideal to use face mask oxygen for Pneumothorax.
Most Pneumothorax are made of Nitrogen, O2 ↓ the partial pressure of N2 in the blood, thus ↑ the gradient for the reabsorption of the pneumothoraces
State the urgent management of tension Pneumothorax.
Needle thoracostomy: IV large bore cannula at the 2 intercostal space mid clavicular line perpendicular to the Pneumothorax.
Give oxygen as well
Define tension Pneumothorax
Progressive build up of air in the pleural space leading to build up of pressure that leads to mediastinal shift and decreased venous return to the heart
