Pneumothorax Flashcards
are usually due to rupture of apical pleural blebs,small cystic spaces that lie within or immediately under the visceral Pleura.
Primary spontaneous pneumothoraxes
Primary spontaneous pneumothoraxes occur almost exclusively in;
smokers
The initial-recommended treatment for primary spontaneous pneumothorax is
simple aspiration
In Primary spontaneous pneumothoraxes,
If the lung does not expand with aspiration or if the patient has a recurrent pneumothorax, what’s next?
thoracoscopy with stapling Of blebs and pleural abrasion is indicated.
Most secondary pneumothoraxes are due to what Lung disease
(but secondary pneumothoraxes have been reported with virtually every lung disease)
chronic obstructive pulmonary disease
Primary treatment for secondary spontaneous pneumothoraxes
Tube thoracostomy
thoracoscopy
Thoracotomy with staplingof blebs and pleural abrasion
treatment for secondary spontaneous pneumothoraxes if not a candidate for surgery
PLEURODESIS with instillation of a sclerosing agent (Doxycycline)
Primary treatment for traumatic pneumothorax
Tube thoracostomy unless very small
Primary treatment for traumatic pneumothorax with hemopneumothorax
One chest tube should be placed in the superior part of the hemithorax to-evacuate the air and another should be placed in the inferior part of the hemothorax to remove the blood
Iatrogenic pneumothorax is a type of traumatic pneumothorax that is becoming more common. The leading causes are
transthoracic needle aspiration
thoracentesis
and the insertion of central intravenous catheters.
Primary treatment for iatrogenic pneumothoraxes
Most can be managed with supplemental oxygen or aspiration, but if these measures are unsuccessful,a tube thoracostomy should be performed.
This condition usually occurs during mechanical ventilation or resuscitative efforts. The positive pleural pressure is life-threatening both because ventilation is severely compromised and because the positive pressure is transmitted to the mediastinum, resulting in decreased venous return to the heart and reduced cardiac output.
Tension pneumothorax
Difficulty in ventilation during resuscitation or high peak inspiratory pressures during mechanical ventilation strongly suggest thediagnosis
Tension pneumothorax
The diagnosis is made by physical examination showing an enlarged hemithorax with no breath sounds, hyperresonance to percussion, and shift of the mediastinum to the contralateral side
Tension pneumothorax
What is the primary treatment for tension pneumothorax?
A large-bore needle should be inserted into the pleural space through the second anterior intercostal space. If large amounts of gas escape from the needle after insertion, the diagnosis is confirmed. The needle should be left in place until a thoracostomy tube can be inserted.
