Pneumothorax Flashcards
Causes of a Spontaneous Pneumothorax
- Unknown
- Rupture of sub pleural air filled sacs called blebs
- COPD (70% cases)
- Asthma
- Cystic fibrosis
- Marfan’s syndrome
Causes of a Tension Pneumothorax
- Penetrating or blunt trauma
- Mechanical ventilation or non-invasive ventilation
- Conversion of spontaneous
Signs of a Pneumothorax
- Tachycardic
- Tachypnoea
- Increased WOB (muscle use)
- Wheeze/reduced breath sounds on affected sounds
- Hypoxia
- Hyper-inflated chest (hard to BVM)
- Hyper-resonant on affected side
Late Signs of a Tension Pneumothorax
- Deviated trachea
- PEA arrest
- Increased JVP
- Cardiovascular collapse
Primary Sruvey in Pneumothorax (A-D)
A - might not be patent
B - Increased WOB, not talking in full sentences, cyanosis, decreased sats, unequal rise and fall
C - decreased CRT, pale, JVP?
D - altered mental status
IPPA Findings in Pneumothorax
I - inspect for increased WOB, tachypnoea, signs of trauma, hyper-inflation, unequal chest rise, muscle use, abnormal breathing patterns
P - palpate for pain, emphysema, crepitus
P - hyperresonance on affected side
A - reduced or no air entry on affected side
History for a Pneumothorax; PMH ect
- History of trauma?
- PMH of any lung conditions? COPD, asthma, cystic fibrosis, cancer
- What medications do they take? (could indicate lung problems)
- Allergies (could indicate reaction, anaphylaxis)
- FH - autoimmune diseases, lung problems
- SH - smoking, drugs, travel and exposure to chemicals
Oxygen Therapy for a Pneumothorax
- 15L in trauma
- Titrate to 94-98 if the patient is at risk of hypercapnic respiratory failure
- Be aware of COPD hypoxic drive when administering
Needle Thoracentesis
- Only indicated if the pneumothorax has tensioned and showing signs of haemodynamic instability
- Diagnose based off symptoms and history
- Use largest bore cannula (orange) in second intercostal space, just above the third rib. Mid-clavicular line
- Note that CCPs can do a needle thoracostomy as a more diagnostic and more successful temporising measure
- Can and probably will retention naturally or due to cannula blocking
- Definitive treatment is finger hole thoracostomy (CCP) or chest drain in hospital
Open Pneumothorax Treatment
- Chest seal or Russel chest seal
- Could create a 3 sided occlusive dressing with gauze and three bits of tape
- This will mean that when air is sucked in through the mouth, it won’t be sucked in from the atmosphere but still allows the air to escape through that hole
Things to Note for Pneumothorax
- If alive and spontaneously breathing let them keep doing negative pressure breathing to counteract the positive pressure pneumothorax
- As soon as tired/dead start provide BVM - this is positive pressure which will increase the pressure further (NEEDS decompression)
- No entonox
- Needs constant reassessment
Pain Releif Treatment for Pneumothorax
- Morphine preferred pain relief if bp allows
- IVP good
- No Entonox as can enlarge the pneumothorax
Normal Patient Meds (2)
- Cystic Fibrosis Meds - mucolytics (thin mucus)
- Bronchodilators is COPD asthma ect
List of Differential Diagnosis Pneumothorax
- Asthma
- MI
- Aortic dissection
- Acute pericarditis
- PE
- Thoracic trauma
- Asthmatic Pneumothorax
- EXT list; bronchitis, COPD, foreign body obstruction, pleural effusion, heart failure
