Pneumothorax Flashcards
What is a pneumothorax?
Accumulation of air in the pleural space resulting in partial or complete collapse of the affected lung
What are the classifications of pneumothoraces?
Spontaneous - Primary or secondary
Traumatic pneumothroax - Penetrating or blunt chest trauma
Iatrogenic pneumothorax - Occurs as a complication of medical procedure’s such as thoracocentesis or central venous catheter placement
What is a primary spontaneous pneumothorax?
Occurs without underlying lung disease. Normally occurs in tall, thin, young individuals. Associated with rupture of subpleural blebs.
What is a secondary spontaneous pneumothorax?
Occurs in patients with underlying lung conditions such as COPD, asthma, CF, lung cancer, PCP or connective tissue disease.
What is a tension pneumothorax?
Severe pneumothorax which displaces the mediastinal structures resulting in severe respiratory distress and haemodynamic collapse (due to reduced venous return to the heart). May occur following trauma when a lung parenchymal flap is created which acts as a one way valve
What is a catamenial pneumothorax?
It is a cause of spontaneous pneumothoraces occurring in menstruating women. Thought to be due to endometriosis within the thorax
What are the signs and symptoms of a pneumothorax?
Symptoms - Dyspnoea and pleuritic chest pain.
Signs - Hyper-resonant lung percussion, reduced breath sounds, reduced lung expansion, tachypnoea, tachycardia
What are the signs of a tension pneumothorax?
Respiratory distress,
Tracheal deviation away from side of pneumothorax,
Hypotension
What are the investigations for a pneumothorax?
Chest X ray,
abg
What is the discharge advice following a pneumothorax?
Follow up in outpatients in 2-4 weeks
Smoking cessation
Must not fly until 7 days after radiological resolution
Permanently avoid scuba diving
What it the management of a tension pneumothorax?
A-E assessment
Urgent needle decompression with 16G canula in the 2nd intercostal space, mid clavicular line just above the third rib
What are some of the treatment options for recurrent pneumothorax?
VATS (video-assisted thoracoscopic surgery) -Pleurodesis - talc into pleural space. Can be done via intercostal drain or thoracic surgery
Bullectomy
What is the management of a pneumothorax?
Depends if patient is symptomatic or asymptomatic.
If asymptomatic - conservative care no mater the size.
If symptomatic then need to assess if high risk features present or not.
If symptomatic and high risk features are present then insert chest drain.
If symptomatic and no high risk features present then can either do conservative care, ambulatory device or needle aspiration
What are the high risk features characteristics of a pneumothorax?
Hemodynamic compromise,
Significant hypoxia,
Bilateral pneumothorax,
Underlying lung disease,
Age 50+ with significant smoking history,
Haemothroax
What are the features of conservative care?
Primary spontaneous pneumothorax - review every 2-4 days as outpatient.
Secondary spontaneous pneumothorax managed as inpatient.
