Pneumothorax Flashcards
How does a traumatic pneumothorax occur?
problem with parietal pleura (eg. pierced during surgery/stabbed)
obliterates negative pressure in pleural space
therefore lung deflates
Pneumothorax acute onset symptoms
pleuritic chest pain
breathlessness
Examination features of a pneumothorax
trachea/mediastinum pushed
reduced/absent expansion
hyper-resonant percussion
reduced/absent breath sounds
hypoxemia (especially if underlying lung disease present)
Difference between primary and secondary spontaneous pneumothoraces
primary = no underlying lung pathology
secondary = lung disease or significant smoking history
Secondary spontaneous pneumothorax causes
connective tissue disease (eg. Marfan’s, Ehlers-Danlos)
obstructive lung disease (eg. asthma, COPD)
infective lung disease (eg. TB, pneumonia)
fibrotic lung disease (eg. CF, IPF)
neoplastic disease (eg. bronchial carcinoma)
How can you sub-classify traumatic pneumothoraces?
iatrogenic (eg. pacemaker insertion, central line insertion, CPAP)
non-iatrogenic (eg. penetrating trauma, blunt trauma with rib fracture)
Define pneumothorax
air within the pleural space
How does a pneumothorax show on a CXR?
absence of lung markings at periphery
pleural separation line
Where is the size of a pneumothorax measured?
horizontally at the hilar level from the pleural separation line top the wall of the thorax
Define tension pneumothorax
not a mechanism
pneumothorax so large it’s causing haemodynamic compromise
Tension pneumothorax signs
low BP
low HR
tachypnoea
tracheal deviation
How is a tension pneumothorax treated?
large bore needle decompression
2nd intercostal space (just above 3rd rib)
mid-clavicular line
What are the borders of the safe triangle?
anterior = lateral border of pectoralis major
superior = base of axilla
inferior = line of 5th intercostal space
lateral = lateral edge of latissimus dorsi
Why should a needle be inserted above the rib and not below it with a needle decompression?
go above rib to avoid neurovascular bundle
Where should a chest drain be inserted?
safe triangle
Chest drain complications
pain/infection
drain dislodgement
drain blockage
visceral injury
death
When can someone who has had a pneumothorax fly?
at least 1 week after pneumothorax has resolved
When can someone who has had a pneumothorax scuba dive?
never
increases risk of pneumothorax recurrence
What can be done for recurrent or non-resolving pneumothoraces?
medical chemical pleurodesis
What should be done if a pneumothorax has not settled after 5 days with a drain?
VATS (video-assisted thoracoscopic surgery)
Treatment for:
primary pneumothorax, >2cm/breathless
aspirate
16-18G cannula
aspirate <2.5L
Treatment for:
primary pneumothorax, <2cm/asymptomatic
consider discharge
review in outpatients in 2-4 weeks
Treatment for:
unresolved primary pneumothorax after aspiration
chest drain
Treatment for:
secondary pneumothorax, >2cm/breathless
chest drain
Treatment for:
secondary pneumothorax, 1-2cm + not breathless
aspirate
16-18G cannula
aspirate <2.5L
Treatment for:
secondary pneumothorax <1cm + not breathless
admit
high flow oxygen (unless expected oxygen-sensitive)
observe for 24 hours
Treatment for:
unresolved 1-2cm secondary pneumothorax after aspiration
chest drain
Further management if aspiration of a 1-2cm secondary pneumothorax is successful and size is now <1cm?
admit
high flow oxygen (unless expected oxygen-sensitive)
observe for 24 hours
chance of recurrence high
