Pneumothorax Flashcards

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1
Q

Pneumothorax

A

Air gets into pleural space separating lung from chest wall

Can occur spontaneously or secondary to trauma, medical interventions or lung pathology

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2
Q

Risk factors

A

Pre-existing lung disease

Connect tissue disease (Marfan’s, rheumatoid arthritis)

Ventilation (including non-invasive)

Catamenial pneumothorax

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3
Q

Catamenial pneumothorax

A

3-6% of spontaneous pneumothoraces in menstruating women

Caused by endometriosis within thorax

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4
Q

Symptoms

A

Dyspnoea

Chest pain (often pleuritic)

Sweating

Tachypnoea

Tachycardia

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5
Q

Investigations

A

Erect chest xray

Absence of lung markings

CT thorax can detect small pneumothorax too small to be seen on xray

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6
Q

Management

A

No SOB and <2cm rim of air
- no treatment required
- resolves spontaneously
- follow up in 2-4 weeks

SOB and/or >2cm rim of air
- aspiration and reassessment

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7
Q

If aspiration fails twice

A

Need chest drain

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8
Q

Management of unstable patients

A

Or bilateral or secondary pneumothoraces

Require chest drain

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9
Q

Tension pneumothorax

A

Chest wall creates a one-way valve that lets air in but not out of pleural space

During inspiration air drawn in and during expiration trapped

Creates pressure in thorax, pushes mediastinum across, kink big vessels and cause cardiorespiratory arrest

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10
Q

Signs of tension pneumothorax

A

Tracheal deviation away from side of pneumothorax

Reduced air entry to affected side

Increased resonant to percussion on affected side

Tachycardia

Hypotension

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11
Q

Management of tension pneumothorax

A

Insert large bore cannula into second intercostal space in midclavicular line

Once pressure is relieved then a chest drain required for definitive management

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12
Q

Chest drains placement

A

Triangle of safety

Just above rib to avoid neurovascular bundle that runs below rib

Chest xray to check positioning

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13
Q

Triangle of safety

A

5th intercostal space (inferior nipple line)

Mid axillary line (lateral line of latissimus dorsi)

Anterior axillary line (lateral edge of pec major)

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