Pneumothorax Flashcards
What is a pneumothorax?
When air gets into pleural space separating lung from chest wall
What would the typical patient with a pneumothorax look like?
Young, Tall, thin man who was likely playing sport
- will be breathless with chest pain
What are the causes of pneumothorax?
- Spontaneous
- trauma
- Iatrogenic e.g. due to lung biopsy, mechanical ventilation or central line insertion
- lung pathology e.g. infection, asthma or COPD
What investigation should be carried out to check for pneumothorax?
CXR - Pneumothorax should be measured horizontally from lung edge to inside of chest wall at level of hilum
CT thorax - can detect small pneumothorax that can’t be seen on CXR
How are pneumothorax’s managed?
- no SOB and more than 2 cm of air on CXR then no treatment required as will spontaneously resolve
- if SOB and more than 2 cm of air on CXR then will require aspiration and reassessment
- If aspiration fails twice will require chest drain
- unstable patients or bilateral or secondary pneumothoraces generally require chest drain
What is a Tension Pneumothorax?
- trauma to the chest wall creates a one-way valve that lets air in but not out of the pleural space
- during inspiration air moves in and during expiration air is trapped
- creates pressure in the thorax
What do tension pneumothoraces cause?
- mediastinum pushed across the chest
- kink the big vessels of the mediastinum
- cause cardiorespiratory arrest
What are the signs of a tension pneumothorax?
- tracheal deviation away from side of pneumothorax
- reduced air entry to affected side
- increased resonant to percussion on affected side
- tachycardia
- hypotension
How are tension pneumothoraces managed?
- Insert large bore cannula into the second IC space in the midclavicular line
- then use chest drain to drain
Where are chest drains inserted?
area between:
- 5th IC space
- Midaxillary
- anterior axillary line
Needle inserted just above the rid to avoid the nerovascular bundle
Check position on CXR
