Pneumothorax Flashcards
What is a pneumothorax?
When air gains access to, and accumulates in, the pleural space.
What is the aetiology of primary spontaneous pneumothorax?
Without preceding trauma/precipitating event, develops in person without significant lung disease. Risk factors: smoking, FHx, Marfan’s, young thin men.
What is the aetiology of secondary spontaneous pneumothorax?
Occurs as a complication of an underlying pulmonary disease (COPD most common). Severity of lung pathology increases the risk.
What is the aetiology of a tension pneumothorax?
Can complicate primary and secondary. Medical emergency with mediastinal shift and respiratory failure.
What is this a presentation of?
Sudden onset dyspnoea, pleuritic chest pain, sudden deterioration in asthma/COPD. Reduced expansion, hyperresonant, diminished breath sounds, decreased vocal fremitus.
Pneumothorax
How is a suspected pneumothorax investigated?
- Clinical diagnosis
- Incidental finding on CXR - measure rim of air between lung margin and chest wall at the level of hilum.
- ABG - for those who are hypoxic or with chronic lung disease.
What is the management of a pneumothorax?
- Conservative if small - O2 therapy until it resolves
- Primary - if >2cm aspirate with 16-18G cannula, if <2cm discharge and follow-up.
- Secondary - if >2cm chest drain 8-14Fr, if 1-2cm aspirate as above, if <1cm admit with high flow O2 and observe.
Where is a chest drain inserted for a pneumothorax?
Square area with 4 borders:
- Lateral pectoralis major
- Base of axilla
- Anterior latissimus dorsi
- 5th intercostal space
Where is an aspirate carried out in a pneumothorax?
2nd intercostal space, midclavicular line (or 5th, mid-axillary line). Can aspirate up to 2.5L.
What should you do after treating a pneumothorax and what advice should you give for preventing recurrence?
- CXR to confirm resolution, avoid air travel for 1 week, permanently avoid diving.
- Stop smoking to reduce recurrence.
What are the indications for surgical management of pneumothorax?
- Bilateral pneumothoraces
- Lungs fail to expand within 48hrs of intercostal drain insertion.
- 2 or more previous pneumothoraces on same side.
- Hx of pneumothorax on contralateral side.