Pneumothorax Flashcards
What is a pneumothorax?
Air within the pleural space (collapsed lung)
What are the causes of a pneumothorax divided into?
Spontaneous
Traumatic
What are the spontaneous causes of a pneumothorax divided into?
Primary
Secondary
What is a primary pneumothorax due to?
No underlying pathology
What is a secondary pneumothorax due to?
Underlying pathology
What are the traumatic causes divided into?
Iatrogenic
Non-iatrogenic
What do the iatrogenic causes include?
Insertion of a central line
Positive pressure ventilation
Lung biopsy
What are the non-iatrogenic causes?
Penetrating trauma
Blunt trauma with rib fracture
What are the main presentations of a pneumothorax?
Sudden onset of:
Shortness of breath (dyspnoea)
Chest pain on inspiration
What other symptoms of a pneumothorax?
Sweating
tachycardia
tachypnoea
What clinical signs would you expect on the affected side?
Reduced chest expansion
Hyper-resonant percussion
Reduced or absent breath sounds
Reduced vocal resonance
What additional signs would you expect with a tension pneumothorax?
Tracheal deviation to the contralateral side
Signs of haemodynamic compromise
What is the main investigation for a pneumothorax?
Chest x-ray
Erect chest x-ray
What is the management of a primary pneumothorax if the patient is not short of breath and the pneumothorax is less than 2cm on chest x-ray?
Conservative management
Patient is discharged and seen at outpatient in 2-4 weeks
What is the management of a primary pneumothorax if the patient is short of breath or the pneumothorax is more than 2cm on chest x-ray?
Aspirate under local anaesthetic
If successful-discharge patient
If unsuccessful after 2 attempts - intercostal chest drain
What would you do if the aspiration failed to resolve the pneumothorax?
Intercostal drain
What is the management of a secondary pneumothorax if the patient is NOT short of breath AND the pneumothorax is <1 cm on the chest x-ray
No further invasive intervention
Admit for observation for 24 hours
Administer oxygen as required.
What is the management of a secondary pneumothorax if the patient is NOT short of breath and the pneumothorax is 1-2 cm on the chest x-ray
Aspiration is required
If successful- Patient can be admitted for 24 hours of observation
Unsuccessful- intercostal drain
What is the management of a secondary pneumothorax if the patient is short of breath and the pneumothorax is >2 cm on the chest x-ray?
An intercostal drain is necessary (and the patient should be admitted).
What is the management for a tension pneumothorax?
High flow oxygen (15 L/min)
Immediate needle decompression- inserted at the second intercostal space, mid-clavicular line, on the affected side.
Where should the needle be inserted in the management of a tension pneumothorax?
Needle should be inserted just above the third rib, to avoid damaging the neurovascular bundle
What is done after insertion of the needle in the management of a tension pneumothorax?
The needle decompression acts as a bridge before insertion of an intercostal chest drain.
What are the possible underlying pathological causes of a pneumothorax?
Marfan’s syndrome
Asthma
COPD
Pneumonia
CF
What is classed as the triangle of safety for the insertion of a chest drain?
Base of axilla, lateral pectoralis major, 5th intercostal space, anterior latissimus dorsi
What are risk factors for a spontaneous primary pneumothorax?
Tall, thin, male smoker
What are risk factors for a spontaneous secondary pneumothorax?
COPD
Asthma
Marfan’s
What are risk factors for traumatic pneumothorax?
Recent chest trauma,
Recent invasive medical procedure
Who is usually affected by a spontaneous primary pneumothorax?
Tall, young, thin, men who smoke
What is usually present in most cases of spontaneous primary pneumothorax?
Subpleural blebs and bullae
What is a tension pneumothorax due to?
Air leaks into pleural space during inspiration, can’t escape during expiration
What does a tension pneumothorax cause?
Increased intrapleural pressure resulting in mediastinal shift and impaired cardiac function
Which way will the trachea deviate in a tension pneumothorax?
To the unaffected side
What is the initial management of a tension pneumothorax?
ABCDE
High flow oxygen
Needle decompression using a 16-gauge cannula
Where should the needle be inserted in a tension pneumothorax?
Second intercostal space, mid-clavicular line, on the affected side- just above the 3rd rib (avoid neurovascular)
When can a tension pneumothorax occur?
May occur following thoracic trauma when a lung parenchymal flap is created.
