Pneumothorax Flashcards
What is primary pneumothorax?
spontaneous pneumothorax
What classic patient ‘type’ does pneumothorax present in?
young, tall, slim men
What is often the cause of primary pneumothorax?
rupture of a pleural bled (thin walled air containing space thought to be congenital defects in the connective tissue of the alveolar walls)
What is secondary pneumothorax?
pneumothorax occurring in conjunction with pre-existing lung diseases such as COPD, infection or cystic fibrosis OR iatrogenic causes such as instrumentation of the thorax
Give 4 clinical presentations associated with simple pneumothorax:
1) sudden onset chest pain (unilateral)
2) sudden onset breathlessness
3) shock
4) similar symptoms in the past but not sought medical attention
What is imaging technique is used to diagnose pneumothorax?
plain X-ray (assess the pleura to edge lung distance
When would a CT scan be used to investigate pneumothorax?
if the thorax remains abnormal following resolution of the pneumothorax
Describe the affect recreational drug use has on pneumothorax risk:
drugs like cannabis cause bullae and associated emphysema, therefore increasing pneumothorax risk
When would observation/ monitoring be used to manage pneumothorax?
for patients with mild symptoms and a pneumothorax of <2cm
Give 3 pieces of discharge advice given to those recovering from a recent pneumothorax:
1) do not fly
2) do not go diving
3) stop smoking
When would aspiration be used to manage pneumothorax?
for symptomatic patients with a pneumothorax of >2cm
Give 3 pieces of equipment used in lung aspiration for pneumothorax?
1) French gauge needle
2) three-way tap
3) 50mL syringe
True or false: aspiration is used in treatment of traumatic pneumothorax
false - aspiration is contraindicated in traumatic pneumothorax
What imaging is used to assess lung reinflation in pneumothorax treatment?
repeat chest X-ray
When is a pleural intercostal drain used to treat pneumothorax? (3)
1) if aspiration fails to inflate the lungs
2) the patient is very breathless
3) patient has tension pneumothorax
Where should a pleural intercostal drain be inserted?
mid-axillary line in the 4th intercostal space
Describe how a pleural intercostal drain works?
a tube is inserted into the mid-axillary line, 4th intercostal space which is connected to an underwater drain or bottle which are kept below the level of the patient’s chest
What is pleurodesis?
Artificial production of adhesions between the parietal and visceral pleura, usually done with a chemical sclerosing agent, such as talc or doxycycline
What is a ‘recurrent’ pneumothorax defined as?
any case where pneumothorax has occurred more than once
What is a potential complication associated with lung aspiration or chest drain?
re-expansion pulmonary oedema (sudden re-expansion leads to fluid in lung parenchyma for unknown reason)
What is tension pneumothorax?
severe pneumothorax involving displacement of the mediastinal structures and haemodynamic compromise often cause by trauma creating a one-way parenchymal flap
Give three findings associated with pneumothorax that may be found in a full respiratory examination:
1) affected lung is hyper-resonant on percussion
2) tracheal deviation AWAY from the affected side
3) auscultation-reduced breath sounds
Describe the pathophysiology of pneumothorax:
alveolar and atmospheric pressure is greater than intrapleural pressure meaning any connections between alveoli and pleural space will lead to air moving down a pressure gradient, increasing intrapleural pressure, compressing the lung
What signs are displayed in a tension pneumothorax?
- respiratory distress
- tracheal deviation away from the side of the pneumothorax
- hypotension
What is a iatrogenic pneumothorax?
occurs as a complication of medical procedures, such as thoracentesis, central venous catheter placement, ventilation, including non-invasive ventilation or lung biopsy
How should a tension pneumothorax be managed?
Assess if it is safe to intervene
Chest drain
What are the high-risk characteristics for a pneumothorax?
haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax
IF high-risk characteristics are present but it isn’t safe to intervene what should be done?
CT imaging and reassess
