pneumothorax Flashcards
what is a pneumothorax?
Air within the pleural space.
separates lung from chest wall.
causes of spontaneous pneumothorax?
primary = No underlying cause:
- tall, thin, young male.
secondary + underlying cause:
- infection (TB, pneumonia)
- asthma
- COPD
- marfans syndrome
- cystic fibrosis
causes of traumatic pneumothorax?
iatrogenic:
- lung biopsy
- central line insertion
- mechanical ventilation
Non-iatrogenic:
- trauma
what are the signs of a pneumothorax?
reduced lung expansion
reduced breath sounds
decreased vocal resonance
hyper resonant percussion note
risk factors for pneumothorax?
risk factors for pneumothorax?
tall male thing young smoker trauma COPD asthma cystic fibrosis marfans syndrome (any connective tissue disorder)
what investigation is done for a pneumothorax?
standing chest Xray.
what can a CT scan show?
size of pneumothorax
smaller pneumothorax that can’t be seen on X-ray.
signs of tension pneumothorax?
tracheal deviation
tachycardia
hypotension
what is the treatment for a tension pneumothorax?
insert large bore cannula into 2nd intercostal space on the mid clavicular line.
Later - insert chest drain.
what is the treatment for a primary pneumothorax?
- No SOB and size <2cm = conservative with follow up in 2-4 weeks.
- SOB or >2cm = aspiration under local anaesthetic, if this fails use chest drain.
what is the treatment for a secondary pneumothorax?
- No SOB and <1cm = conservative management and surveillance.
- No SOB, size 1-2cm = aspiration then surveillance.
- SOB >2cm = chest drain insertion.
where should the chest drain be inserted into?
Triangle of safety - 5th intercostal space (bottom), mid axillary line and anterior axillary line.
ABOVE rib - avoids neuromuscular bundle.
what is the surgical management of a pneumothorax?
Pleurodesis - either irritation or chemical.
pleurectomy.
