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Year One - Respiratory System > Pneumothorax > Flashcards

Pneumothorax Flashcards

1
Q

What is another term for a pneumothorax?

A

Collapsed lung

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2
Q

What is a pnuemothorax?

A

It is a condition in which air enters the pleural space – resulting in separation of the lung and the chest wall

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3
Q

What is the pleural space?

A

It is the cavity between the visceral and parietal pleura

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4
Q

Describe how the lung physiologically inflates, and how this is disrupted in pneumothorax patients

A

In physiological circumstances, there is a negative intrapleural pressure, this is due to a combination of lung recoiling and expenditure of the chest wall

This negative pressure is present at all stages of respiration, enabling expansion of the lung as it is pulled towards the chest wall

In a pneumothorax, there is an increase in intrapleural pressure resulting in the lung being unable to fully reinflate

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5
Q

What are the three main classifications of pneumothorax?

A

Spontaneous pneumothorax

Traumatic pneumothorax

Tension pneumothorax

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6
Q

What is a spontaneous pneumothorax?

A

It is defined the sudden onset of a pneumothorax without any underlying trauma

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7
Q

What are the two subclassifications of a spontaneous pneumothorax?

A

Primary Spontaneous Pneumothorax

Secondary Spontaneous Pneumothorax

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8
Q

What is a primary spontaneous pneumothorax?

A

It is defined as the sudden onset of a pneumothorax without any underlying trauma, and in the absence of lung disease

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9
Q

What are the five risk factors of a primary spontaneous pneumothorax?

A

Tall Thin Young Male

Family History

Smoking

Pregnancy

Marfan’s Syndrome

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10
Q

What is a secondary spontaneous pneumothorax?

A

It is defined as the sudden onset of a pneumothorax without any underlying trauma, and in the presence of pre-existing lung disease

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11
Q

What five lung diseases are associated with secondary spontaneous pneumothorax?

A

COPD

Asthma

Pneumonia

Lung Cancer

Cystic Fibrosis

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12
Q

What is a traumatic pneumothorax?

A

It is defined as the sudden onset of a pneumothorax, related to trauma to the chest wall

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13
Q

What are the two subclassifications of traumatic pneumothorax?

A

Iatrogenic Traumatic Pneumothorax

Non-Iatrogenic Traumatic Pneumothorax

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14
Q

What is an iatrogenic traumatic pneumothorax?

A

It is defined as the sudden onset of a pneumothorax, related to trauma to the chest wall which is secondary to medical intervention

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15
Q

What four medical procedures are associated with iatrogenic traumatic pneumothorax?

A

Central Line Placement

Ventilation

Lung Biopsies

CPR

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16
Q

What is a non-iatrogenic traumatic pneumothorax?

A

It is defined as the sudden onset of a pneumothorax, related to trauma to the chest wall which is not secondary to
medical intervention

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17
Q

What are the four injured associated with non-iatrogenic traumatic pneumothorax?

A

Motor Vehicle Accident

Fractured Ribs

Contact Sport injuries

Stab Wounds

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18
Q

What is a tension pneumothorax?

A

It isn’t defined as a pneumothorax classification, however, is a term used to reflect its severity

It is caused by trauma to the chest wall that creates a one way valve that enables air into the pleural space, however not out

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19
Q

Why are tension pneumothoraxes life threatening?

A

They create increased pressure inside the thorax

This pushes the mediastinum across, kinks the big vessels in the mediastinum and causes cardiorespiratory arrest

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20
Q

What are the five clinical features associated with tension pneumothorax?

A

Tracheal Deviation

Air Entry Reduction

Increased Percussion Resonance

Tachycardia

Hypotension

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21
Q

In tension pneumothorax, which side does the trachea deviate to?

A

It deviates away from the side of the pneumothorax

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22
Q

In tension pneumothorax, which side is there reduced air entry?

A

The side affected by a pneumothorax

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23
Q

Which two clinical observations makes the diagnosis of tension pneumothorax more likely than simple pneumothorax?

A

Hypotension

Deterioratoin > Ventilation

24
Q

How do we treat tension pneumothorax?

A

We insert a large bore cannula into the second anterior intercostal space in the midclavicular line

Once pressure has been relieved, a chest drain is inserted for definitive management

25
Q

Do we conduct investigations in tension pneumothorax cases?

A

No it is important to start treatment immediately

26
Q

What are the five risk factors of a pneumothorax?

A

Male Gender

Young Age

Pre-Existing Lung Disease

Connective Tissue Disease

Ventilation

27
Q

What are the five lung diseases associated with pneumothorax?

A

Asthma

COPD

Cystic fibrosis

Lung cancer

Pneumocystis pneumonia

28
Q

What are the two connective tissue diseases associated with pneumothorax?

A

Marfan’s syndrome

Rheumatoid arthritis

29
Q

Describe the typical pneumothorax patient

A

A tall, thin young man presenting with sudden breathlessness and pleuritic chest pain - potentially whilst playing sports

30
Q

What are the eight clinical features of a pneumothorax?

A

Shortness of Breath

Ipsilateral Pleuritic Chest Pain

Cyanosis

Tachycardia

Tachypnoea

Hypotension

Hyperresonance

Enlarged Jugular Vein

31
Q

What are the two investigations used to diagnose a pneumothorax?

A

Chest X-Ray (CXR)

CT Scan

32
Q

What is the first line investigation used to diagnose a pneumothorax?

A

CXR

33
Q

What are the two signs of a pneumothorax on CXR?

A

No Peripheral Lung Markings

Mediastinal Shift

34
Q

What is an additional function of a CXR in pneumothorax patients?

A

It can be used to measure the size of the pneumothorax

It would involve measuring horizontally from the lung edge to the inside of the chest wall at the level of the hilum

35
Q

What is the second line investigation used to diagnose a pneumothorax? When is it usually required?

A

CT scan

In small pneumothoraxes which CXR scans are unable to detect

36
Q

What is an additional function of a CT scan in pneumothorax patients?

A

It can be used to measure the size of the pneumothorax

It would involve measuring horizontally from the lung edge to the inside of the chest wall at the level of the hilum

37
Q

When is pneumothorax treatment not recommended? What should be done in these patients?

A

Primary pneumothorax patients without dyspnoea and < 2cm rim of air on imaging

Dishcarge and review

38
Q

How do we manage a secondary pneumothorax < 1cm?

A

We admit these patients, administer oxygen and review in 24 hours

39
Q

What is fluid aspiration?

A

It involves collecting a sample of pleural fluid via the insertion of a needle

It is usually conducted under ultrasound guidance

40
Q

In which pneumothorax patients is fluid aspiration recommended?

A

Dyspnoea features

AND/OR

< 2cm rim of air on imaging

41
Q

What is a chest drain?

A

It involves collecting a sample of pleural fluid via the insertion of a drain

It is usually conducted under ultrasound guidance

42
Q

In which four circumstances, do we recommend chest drain insertion to treat a pneumothorax?

A

Unstable Patients

Bilateral Pneumothorax

Secondary Pneumothorax > 2cm

Aspiration Failure On Two Attempts

43
Q

In which region do we insert a chest drain?

A

Triangle of safety

44
Q

What are the three borders that form the triangle of safety?

A

5th Intercostal Space

Mid-Axillary Line

Anterior Axillary Line

45
Q

What anatomical landmark is used to locate the 5th intercostal space?

A

Inferior nipple border

46
Q

Which border of the ‘triangle of safety’ does the 5th intercostal space form?

A

Inferior

47
Q

What anatomical landmark is used to locate the mid-axillary line?

A

Lateral edge of the latissimus dorsi

48
Q

Which border of the ‘triangle of safety’ does the mid-axillary line form?

A

Lateral border

49
Q

What anatomical landmark is used to locate the anterior axillary line?

A

Lateral edge of the pectoris major

50
Q

Which border of the ‘triangle of safety’ does the anterior axillary line form?

A

Anterior border

51
Q

What investigation should be conduced after insertion of a chest drain? Why?

A

CXR

To confirm correct positioning

52
Q

Do we insert the chest drain needle above or below the rib? Why?

A

Above the rib

To avoid the neurovascular bundle that runs just below the rib, containing the long thoracic nerve

53
Q

What occurs when there is damage to the long thoracic nerve?

A

Winging of the scapula

54
Q

What four lifestyle changes are advised to pneumothorax patients prior to discharge, in order to reduce the risk of recurrence?

A

Smoking Cessation

Fitness To Fly 1 Week > Post CXR Check

Diving Avoidance

Seadiving Avoidance Indefinitely

55
Q

What is the single most important lifestyle change individuals can make to reduce their risk of further pneumothoraces?

A

Smoking cessation

56
Q

What drug should not be administered to pneumothorax patients? Why?

A

Nitrous oxide

It can result in the development of a tension pneumothorax. This is due to the fact that nitrous oxide may diffuse into gas-filled body compartments and increase in pressure

Year One - Respiratory System (14 decks)

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