Pneumothorax Flashcards

1
Q

What is a pneumothorax?

A

When air gains access to, and accumulates in, the pleural space.

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2
Q

What is the aetiology of primary spontaneous pneumothorax?

A

Without preceding trauma/precipitating event, develops in person without significant lung disease. Risk factors: smoking, FHx, Marfan’s, young thin men.

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3
Q

What is the aetiology of secondary spontaneous pneumothorax?

A

Occurs as a complication of an underlying pulmonary disease (COPD most common). Severity of lung pathology increases the risk.

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4
Q

What is the aetiology of a tension pneumothorax?

A

Can complicate primary and secondary. Medical emergency with mediastinal shift and respiratory failure.

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5
Q

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.

A

Pneumothorax

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6
Q

How is a suspected pneumothorax investigated?

A
  1. Clinical diagnosis
  2. Incidental finding on CXR - measure rim of air between lung margin and chest wall at the level of hilum.
  3. ABG - for those who are hypoxic or with chronic lung disease.
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7
Q

What is the management of a pneumothorax?

A
  1. Conservative if small - O2 therapy until it resolves
  2. Primary - if >2cm aspirate with 16-18G cannula, if <2cm discharge and follow-up.
  3. Secondary - if >2cm chest drain 8-14Fr, if 1-2cm aspirate as above, if <1cm admit with high flow O2 and observe.
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8
Q

Where is a chest drain inserted for a pneumothorax?

A

Square area with 4 borders:

  1. Lateral pectoralis major
  2. Base of axilla
  3. Anterior latissimus dorsi
  4. 5th intercostal space
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9
Q

Where is an aspirate carried out in a pneumothorax?

A

2nd intercostal space, midclavicular line (or 5th, mid-axillary line). Can aspirate up to 2.5L.

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10
Q

What should you do after treating a pneumothorax and what advice should you give for preventing recurrence?

A
  1. CXR to confirm resolution, avoid air travel for 1 week, permanently avoid diving.
  2. Stop smoking to reduce recurrence.
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11
Q

What are the indications for surgical management of pneumothorax?

A
  1. Bilateral pneumothoraces
  2. Lungs fail to expand within 48hrs of intercostal drain insertion.
  3. 2 or more previous pneumothoraces on same side.
  4. Hx of pneumothorax on contralateral side.
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