Pneumothorax Flashcards
What is pneumothorax
Abnormal collection of air in the pleural space
Aetiology of pneumothorax
Penetrating injury to parietal pleura or rupture of visceral pleura causing:
vacuum to be lost , elastic lung tissue recoils towards the lung root abolishing transmural pressure gradient
Difference between small & large pneumothorax
Small is less than 2cm gap between parietal pleura & lung
Large is greater than 2cm gap
Risk factors of pneumothorax
Tall, slim men & smokers
Symptoms & signs of pneumothorax
SOB
Pleuritic chest pain (acute onset)
Hypoxia
Tachycardia
Reduced breath sounds & chest expansion
Hyper-resonance on percussion
Investigations of pneumothorax
CXR showing absent lung markings & lung edge visible (not expanding to edge of chest wall)
Treatment of small vs large pneumothorax
Always give O2.
Small and asymptomatic = no treatment
Large requires needle aspiration in 4th or 5th ICS mid-axillary line (safe-triangle)
If this fails = chest drain in same position
Why is the safe triangle so important in pneumothorax management
Ensures needle is only going through skin, fascia, muscle layers and parietal pleura AND NOT touching any nerves.
Needs to go through midpoint of ICS as just under and over ribs are neurovascular bundles.
What is a tension pneumothorax
Medical emergency when torn pleura creates a one-way valve air cannot escape on inspiration
Leads to increasing pressure in the pleural space causing mediastinal shift and cardiorespiratory compromise
What does tension pneumothorax look like on x-ray
No lung markings & no lung borders
Increased lung markings on side with no pneumothorax
Clinical presentation of tension pneumothorax
Hypotension (Compressing SVC reduces venous return to heart)
Deviated trachea
Elevated JVP
Tension pneumothorax management
Needle aspiration until chest drain is inserted
Emergency management = needle decompression where large gauge cannula inserted into 2nd or 3rd ICS mid-clavicular line of tension pneumothorax side
