Pneumothorax Flashcards
What is a pneumothorax?
Air in the pleural space
What are the different types of pneumothorax?
Spontaneous, traumatic, iatrogenic, lung pathology, tension
What are risk factors for a pneumothorax?
Smoking, FH, male, tall and slender build, young age, presence of underlying lung disease
What is normal intrapleural pressure?
Negative
What happens in a pneumothorax?
Air flows in to close gradient
How does a pneumothorax present?
Stable patient, sudden onset pleuritic chest pain, dyspnoea, cough
What is the first line investigation?
CXR
What would you see on a CXR?
Reduced/absent lung markings between lung margin and chest wall, visible rim between lung margin and chest wall
When would you do US?
If patient immobile
When would you do CT?
If CXR uncertain
What other tests would you do?
Clotting, ABG
What is a small primary spontaneous PTX?
Visible rim is 2cm or smaller
How do you manage a small primary spontaneous PTX with no SOB?
Consider discharge and follow up CXR in review
How do you manage a large primary spontaneous PTX and/or SOB?
Needle aspiration, if not <2cm on repeat CXR insert chest drain and supplemental O2 if needed, admit
How do you manage a secondary PTX?
Chest drain if large, needle aspiration if small, admit and high flow O2
What is a tension pneumothorax?
A one way valve mechanism, air enters pleural space but cannot exit
What happens in a tension PTX?
Collapse of ipsilateral lung and compression of contralateral trachea, heart and other structures
How does tension PTX present?
Cardiopulmonary deterioration, severe chest pain
How does cardiopulmonary deterioration present?
Hypotension, respiratory distress, low sats, tachycardia, shock
What would you find on examination in tension PTX?
Tracheal deviation to contralateral side, ipsilateral reduced breath sounds, hyperresonance on percussion, hypoxia
How do you manage a tension PTX not due to trauma?
Put out cardiac arrest call, start high flow O2, immediate decompression
How do you manage a tension PTX due to trauma?
Insert a large bore cannula into the pleural space through the second intercostal space in the mid-clavicular line
What sound confirms diagnosis?
Hiss sound
