Pneumothorax Flashcards
What happens in a pneumothorax?
Air enters the pleural space
What are the causes of a pneumothorax?
Spontaneous= rupture of subpleural bulla
-typically occurs in young thin men
Chronic lung disease
- asthma
- COPD
- CF
- lung fibrosis
- sarcoidosis
Lung infection
- TB
- pneumonia
- lung abscess
Traumatic
Iatrogenic
- lung biopsy
- CVP line insertion
- mechanical ventilation
Connective tissue disorders
- Marfans
- Ehlers Danlos syndrome
How might someone with a pneumothorax present?
Asymptomatic
Sudden onset of SOB +/- pleuritic chest pain
Sudden deterioration in COPD or asthma patients
Hypoxia in mechanically ventilated patients or increased ventilation pressures
What signs would indicate a simple pneumothorax?
Reduced chest expansion- asymmetrical
Hyper-resonance on percussion
Diminished breath sounds
What investigations would you do in a simple pneumothorax?
CXR
- loss of lung markings with line demarcating the edge
- peripheral edge of the collapsed lung seen
CT thorax
-can detect pneumothorax too small to be seen on CXR
What does the management of a pneumothorax depend on?
Whether primary or secondary (due to lung condition)
Size of pneumothorax
Symptoms
Whether simple or tension
What are the different forms of management for pneumothorax and when are they indicated?
Nothing with 2-4 week follow up
-no SOB and <2cm rim of air on CXR
Aspiration w/ reassessment
-SOB +/- >2cm rim of air on CXR
Chest drain
- aspiration failed twice
- unstable px
- bilateral
- secondary pneumothorax
What change should you look for in chest drain to indicate the lung has re-expanded?
Tube will stop bubbling due to the air leak having sealed
How does a tension pneumothorax differ from a simple pneumothorax?
Tension pneumothorax is caused by trauma to chest wall which leads to formation of one-way valve allowing air to enter the pleural cavity but not leave
Results in increased pressure in pleural space due to trapped air
-leads to MEDIASTINAL SHIFT which leads to kinking of the great veins-> can cause cardiorespiratory arrest
What are the signs of a tension pneumothorax?
Respiratory distress
Tracheal deviation= away from the side of pneumothorax
Reduced air entry on effected side
Increased resonance
Tachycardia
Distended neck veins
Hypotension
How would you manage a tension pneumothorax?
IMMEDIATELY: (DO NOT WAIT FOR INVESTIGATIONS IF SUSPECTED)
-Insert a large bore cannula into the second intercostal space in the midclavicular line
ONCE PRESSURE RELIEVED:
-Chest drain
What anatomical region must chest drains be inserted into? What are the borders of this region?
Triangle of safety
- 5th intercostal space (inferior horizontal line)
- Midaxillary line (vertical line)
- Anterior axillary line= lateral to pectoris major (superior horizontal line)
Insert needle ABOVE rib to avoid neuromuscular bundle
What should be done after a chest drain is inserted?
CXR- check positioning
How do you determine the size a pneumothorax? What is the criteria for a large pneumothorax?
Measure distance from visible lung edge to chest wall at the level of the hilum
> 2cm= LARGE
How does a chest drain work? What advice needs to be given to people following a chest drain?
One-way valve allowing fluid and air to leave pleural space during expiration and coughing but prevents air being sucked in during expiration
Can never deep see dive
Need to avoid flying for at least 4 weeks
