Pneumothorax Flashcards
What is pneumothorax?
air in the pleural cavity (between lung + chest wall) resulting in collapse of the lung on the affected side
Describe the aetiology of spontaneous pneumothorax
Occurs in healthy people
Typically in tall, thin males
Probably caused by rupture of a subpleural bleb
What is the epidemiology of pneumothorax?
Mainly in 20-60 yr olds
M > F
What are 2 variants of pneumothorax?
Haemothorax: blood
Chylothorax: lymph
Describe the aetiology of secondary pneumothorax
Occurs in patients with pre-existing lung disease (e.g. COPD, asthma, TB)
Describe the aetiology of traumatic pneumothorax
Caused by penetrating injury to the chest e.g. stab wound Often iatrogenic (e.g. central line placement, lung biopsy)
Which disorders predispose to pneumothorax? Give 2 examples
Collagen disorders
Marfan’s syndrome
Ehlers-Danlos syndrome
Which 7 typical clinical situations may a tension pneumothorax arise in?
Ventilated patients.
Trauma patients.
Resuscitation patients (CPR).
Lung disease, esp. acute presentations of asthma + COPD.
Blocked, clamped or displaced chest drains.
Patients receiving non-invasive ventilation.
Patients undergoing hyperbaric oxygen tx
List 5 risk factors for pneumothorax
Smoking: 22-fold increase in M + F 9-fold
Tall
Collagen disorders e.g. Marfans, Ehlers-Danlos
Women with endometriosis with pleuritic/ shoulder/ abdomen pain at time of menses
FH
How does physical exertion affect onset of pneumothorax?
Not usually associated with physical exertion
Onset is just as likely when sedentary
How does primary spontaneous pneumothorax differ to secondary spontaneous pneumothorax?
PSP: minimal or absent
Symptoms are greater in SSP, even if pneumothorax is relatively small in size
Describe 2 symptoms of pneumothorax
Sudden onset pleuritic chest pain
SOB
What 4 general signs of pneumothorax may be found on examination?
May be NO signs if the pneumothorax is small
Signs of respiratory distress- dyspnoea, sweating, cyanosis
Hypotension
Raised JVP
Tachycardia
What 6 signs of tension pneumothorax may be found on examination?
Severe respiratory distress Tachycardia Hypotension Cyanosis Distended neck veins Tracheal deviation away from side of pneumothorax
What 4 signs of pneumothorax may be found on examination of the chest?
Reduced expansion
Hyper-resonance to percussion
Reduced/ absent breath sounds
Tracheal deviation possible
Why perform an ABG in a patient with suspected pneumothorax?
Check for hypoxaemia
Describe the management for a tension pneumothorax
Maximum O2
Insert large bore needle into 2nd ICS MCL
Up to 2.5 L of air can be aspirated
Stop if patient coughs or resistance is felt
Follow-up CXR 2 hrs + 2 weeks later
In which 3 situations may a Chest Drain with Underwater Seal be performed? How?
Aspiration fails
Fluid in the pleural cavity
After decompression of a tension pneumothorax
Inserted in 4th-6th ICS MAL
After excluding tension pneumothorax, what is the aim of management? How is this achieved? What influences this decision?
To relieve dyspnoea.
Simple observation, needle aspiration + chest drain
Choice depends upon the severity of the condition
What does the immediate management of pneumothorax involve?
Supplying Oxygen to relieve hypoxia + accelerate resorption of the pneumothorax 4-fold
What are the management options for recurrent Pneumothoraces?
Chemical pleurodesis (fusing of visceral + parietal pleura with tetracycline or calc) Surgical pleurectomy
Give 2 pieces of advice to a patient who has had a pneumothorax
Avoid air travel until follow-up CXR confirms that pneumothorax has resolved
Avoid diving
What is the prognosis for a pneumothorax patient?
After having 1 pneumothorax, >, 20% will have another
Frequency increases with repeated pneumothoraces
What complications may arise in a pneumothorax patient?
Recurrent pneumothoraces
Bronchopleural fistula
