Pneumothorax Flashcards
What is the normal relationship between the intrapleural pressure and alveolar pressure?
alveolar pressure is greater than the intrapleural pressure, intrapleural pressure is less than atmospheric pressure
Atmospheric pressure>alveolar pressure>intrapleural pressure
How to measure size of a pneumothorax?
from the lung edge to the thoracic waal at the level of the hilum
Patient is not breathless and has pneumothorax 0.9 cm. What is their management?
admitted for observation (<1cm=observation)
Patient is asymptomatic but has pneumothorax 1.8 cm. What is their management?
Aspiration with 16 gauge canula (1-2cm)
Patient breathless and pneumothorax measures 2.5cm, what is their management?
intercostal drain (>2cm)
Landmarks for the triangle of safety when inserting a chest drain?
ant: lateral edge of pec major
Lateral: lateral edge of latissimus dorsi
Inf: fifth intercostal space
Sup: base of axilla
Name the five types of pneumothorax
- Primary spontaneous pneumothorax
- Secondary spontaneous pneumothorax
- Traumatic
- Tension pneumothorax
- Iatrogenic pneumothorax
Provide two examples of iatrogenic causes of pneumothoraces
thoracentesis, during cpr resulting in rib fracture, mechanical ventilation due to barotrauma, central line insertion
What is the indication for large bore cannula insertion into 2nd intercsotal space mid-clavicular line?
tension pneumothorax
Name three clinical findings on resp exam for tension pneumothorax
reduced expansion
hyperresonance (percussion)
decreased breath sounds
no vocal resonance
Name two groups of patients who are at increased risk of developing spontaneous pneumothorax
men (tall and slender) smokers marfan's syndrome FH pneumothorax underlying resp disease e.g. asthma, CF, COPD
Name two factors that need to be taken into account when considering treatment of SP?
severity of symptoms
size of pneumo-
Name two physical signs of tension pneumothorax
tracheal deviations
cardiovascular instability
tachypnoea, hypoxia
When inserting a chest drain, you wish to avoid the costal blood vessels. Where are these located and how can they be avoided?
location- costal grooves on the inferior surface of the ribs
How to avoid- insert the chest drain directly above the rib
Define pneumothorax
accumulation of air in the pleural space secondary to lung collapse
Three causes of pneumothorax?
Spontaneous
Trauma
Iatrogenic
Existing lung pathology (spontaneous secondary)
Two risk factors for primary spontaneous pneumothorax?
thin, tall, man, smoker, young
Two causes of iatrogenic pneumothorax?
NIV
Lung biopsy
Liver biopsy
Two symptoms of pneumothorax?
sudden onset pleuritic chest pain
dyspnoea
tension- resp distress, cardiac arrest
Three signs of pneumothorax on resp examination?
reduced chest expansion
resonant percussion
reduced breath sounds
reduced vocal resonance
Two signs of tension pneumo?
Tachy
Hypotension
mediastinal shift
raised JVP
Two investigations for pneumothorax?
ABG
CXR
US
CT thorax
Patient with SOB and >2cm rim. What is the initial management?
aspiration
If aspiration fails for pneumothorax treatment, what is the subsequent step?
Chest drain
If no SoB and <2cm rim of air on CXR, what is the management of this patient?
no treatment, FU 2-4 weeks
What is the management of tension pneumothorax?
insert large bore catheter into second intercostal space midclavicular line
What are the safety margins for inserting chest drain?
triangle of safety
What are the borders of the triangle of safety?
5th intercostal space
mid axillary line
anterior axillary line (lat edge of pec major)
Two differentials for pneumothorax?
PE
MSK pain
Pneumonia
Which additional surgical intervention is required in tension pneumothorax?
ICD insertion
Patient has right pneumothorax. What will percussion be like on this side?
hyper-resonant to percussion
