Pneumothorax Flashcards
Define pneumothorax
Air in the pleural space
Variants of pneumothorax
2 +3 types
Haemothorax - blood
Chylothorax - lymph
Spontaneous
Secondary
Traumatic
Aetiology of pneumothorax - spontaneous
3
Occur in people w/ typically normal lungs
Typically tall, thin males
Probably caused by rupture of sub pleural bleb
Aetiology of pneumothorax - secondary
Occurs in patients w/ pre-existing lung disease (e.g. COPD, asthma, TB)
Aetiology of pneumothorax - traumatic
2
Caused by penetrating injury to chest Often iatrogenic (e.g. during jugular vein cannulation, thoracocentesis)
Risk factors for pneumothorax
Collagen disorders (e.g. Marfan’s, Ehlers-Danlos)
Epidemiology of pneumothorax
prevalence, age, gender
Annual incidence 9/100,000
Mainly 20-40 yr olds
4x more common in MALES
Presenting symptoms of pneumothorax
4
May be ASYMPTOMATIC if pneumothorax is small
Sudden onset breathlessness
Pleuritic chest pain
Distress w/ rapid shallow breathing in tension pneumothorax
Signs of pneumothorax on physical examination
5
May be NO signs if pneumothorax is small Signs of respiratory distress Reduced expansion Hyper resonance to percussion Reduced breath sounds
Signs of TENSION pneumothorax on physical examination
6
Severe respiratory distress Tachycardia Hypotension Cyanosis Distended neck veins Tracheal deviation away from side of pneumothorax
Investigations for pneumothorax
2 types
CXR
ABG
Investigations for pneumothorax - CXR
2
Will show dark area of film w/ no vascular markings
Fluid level may be seen if there’s any bleeding
Investigations for pneumothorax - ABG
Check for hypoxaemia
Management of pneumothorax
4 groups
Tension pneumothorax
Chest drain w/ underwater seal
Recurrent pneumothoraces
Advice
Management of pneumothorax - tension pneumothorax
5
(EMERGENCY)
Maximum O2
Insert large bore needle into 2nd intercostal space MCL
Up to 2.5L of air can be aspirated
Stop if patient coughs or resistance is felt
Follow up CXR 2hrs & 2 weeks later
Management of pneumothorax - chest drain w/ underwater seal
4
Performed if:
- aspiration fails
- fluid is in pleural cavity
- after decompression of tension pneumothorax
Inserted in 4th-6th intercostal space midaxillary line
Management of pneumothorax - recurrent pneumothoraces
2
Chemical pleurodesis
Surgical pleurectomy
Define pleurodesis
fusing of visceral & parietal pleura w/ tetracycline or calc
Management of pneumothorax - advice
2
Avoid air travel until follow up CXR confirms pneumothorax has resolves
Avoid diving
Complications of pneumothorax
2
Recurrent pneumothoraces
Bronchopleural fistula
Prognosis of pneumothorax
2
After having 1 pneumothorax, at least 20% chance of having another
Frequency increases w/ repeated pneumothoraces
