Pneumothorax Flashcards
What is a pneumothorax?
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall
What are the symptoms associated with a pneumothorax?
Unilateral chest pain
SoB
Tiredness
What is a primary spontaneous pneumothorax?
Pneumothorax occuring in a young adult without underlying lung problems, and usually causes limited symptoms
What is a secondary spontaneous pneumothorax?
individuals with significant underlying lung disease
Symptoms in SSPs tend to be more severe than in PSPs, as the unaffected lungs are generally unable to replace the loss of function in the affected lungs
What are signs of a pneumothorax?
Diminished breath sounds
Hyperresonance
CXR
What is a tension pneumothorax?
Tension pneumothorax is generally considered to be present when a pneumothorax leads to significant impairment of respiration and/or blood circulation.
This causes a type of circulatory shock, called obstructive shock
What is the most common cause of a secondary spontaneous pneumothorax?
COPD
Why, in a physiological state, does air not enter the pleural space - despite its low pressure?
The lungs are fully inflated within the cavity because the pressure inside the airways is higher than the pressure inside the pleural space.
Despite the low pressure in the pleural space, air does not enter it because there are no natural connections to an air-containing passage, and the pressure of gases in the bloodstream is too low for them to be forced into the pleural space
If someone is acute breathless, what oxygen will you give?
For other people who are acutely ill, use a simple face mask at 5-10 L/min or nasal cannulae at 2-6 L/min. Adjust the flow rate to achieve a target oxygen saturation of 94–98%.
If someone is acute breathless with COPD, what oxygen will you give?
28% Venturi Mask at 4 L/min
How are pneumothorex classified?
- Primary spontaneous pneumothorax: pneumothorax occurring in healthy people.
- Secondary pneumothorax:
Associated with underlying lung disease - eg, rupture of a congenital bulla or a cyst in chronic obstructive pulmonary disease (COPD).
The consequences of a pneumothorax in patients with pre-existing lung disease are significantly greater and the management is potentially more difficult.
What is a catamenial pneumothorax?
Catamenial pneumothorax refers to pneumothorax at the time of menstruation.
Over 90% occur in the right lung and it occurs up to 24 hours before or within 72 hours from the onset of menstruation
How would you treat a tension pneumothorax?
Treatment is with oxygen and emergency needle decompression.
Insert a large-bore needle into the pleural space through the second or third anterior intercostal space
Who is at risk of a tension pneumothorax?
Ventilated patients.
Trauma patients.
Resuscitation patients
Lung disease, especially acute presentations of asthma and COPD.
Blocked, clamped or displaced chest drains.
Patients receiving non-invasive ventilation.
Patients undergoing hyperbaric oxygen treatment.
There are different types of pneumothorax, what clinical sign would warn you of a tension pneumothorax?
HR > 135 beats/minute
Also hypotension and raised JVP
What does pulsus paradoxical suggest in a pneumothorax?
Severe!
Pulsus paradoxicus occurs when the pulse slows on inspiration. This is the opposite to sinus arrhythmia where there is a slight acceleration of the pulse with inspiration
What are the management options for primary and secondary spontaneous pneumothorax?
Observation
Simple aspiration
Tube drainage
In pneumothorax, when would you choose a simple aspiration as your management plan?
PSP (any size) and small SSP in patients aged under 50 years
The puncture site is commonly in the second or third intercostal space in the midclavicular line or in the fourth or fifth intercostal space over the superior rib margin in the anterior axillary line
In pneumothorax, when would you choose a tube drainage as your management plan?
A chest drain tube is usually required for SSP and for all large lesions (>50%)
Indications for a chest drain for pneumothorax include:
- In any ventilated patient.
- Tension pneumothorax after initial needle relief.
- Persistent or recurrent pneumothorax after simple aspiration.
- Large SSP in patients aged over 50 years.
In pneumothorax, when would you choose observation as your management plan?
A small pneumothorax of 15% or less can be managed by observation, using both clinical assessment and CXR to ascertain that it is not enlarging
What is the risk of recurrence in a primary spontaneous pneumothorax?
Up to 54% within the first four years
What is the safe triangle and where is it located?
Damage to internal organs can be avoided; this is delineated by a horizontal line at the level of the nipple and two muscles of the chest wall (latissimus dorsi and pectoralis major)
