Pneumothorax Flashcards
What is a pneumothorax?
Where air gets into the pleural space, separating the lung from the chest wall
What is a tension pneumothorax?
A pneumothorax that causes displacement of the mediastinal structures, and compromises cardiopulmonary function
This is due to a one way valve that causes air to enter the lungs, but not exit
What are the causes of pneumothorax?
Iatrogenic
Spontaneous
Trauma
Lung pathologies e.g asthma, COPD, infection
What is the investigation of choice for a simple pneumothorax?
Erect CXR
What are the symptoms of pneumothorax?
Pleuritic chest pain
Sudden onset shortness of breath
Reduced chest expansion
Reduced or absent breath sounds
What kinds of medical conditions can cause pneumothorax?
Connective tissue disease
- Marfan’s disease
- Ehlers-danlos syndrome
Obstructive lung disease
- COPD
- Asthma
Infective lung disease
- TB
- Pneumonia
Fibrotic lung disease
- CF
- Idiopathic pulmonary fibrosis
Neoplastic disease
What are the signs of pneumothorax on examination?
On the affected side:
Reduced or absent breath sounds
Reduced chest expansion
Hyper-resonant percussion
Reduced vocal resonance
What are the additional signs of a tension pneumothorax on examination?
Deviated trachea
Tachycardia
Hypotension
When is a pneumothorax managed conservatively?
If a patient is asymptomatic (regardless of size)
<2cm in size, and no high risk characteristics
What are the high risk characteristics of a pneumothorax?
Haemodynamic instability
Significant hypoxia
Bilateral pneumothorax
Underlying lung disease
50 or older with significant smoking history
Haemopneumothorax
What are the management options for pneumothorax?
Conservative management
Pleural vent ambulatory device
Needle aspiration or chest drain
What is a pleural vent ambulatory device?
A catheter that is inserted into the pleural space, which allows air to exit, but not return
This can be worn as an outpatient until the pneumothorax has resolved
Where is a chest drain inserted?
Into the triangle of safety - formed by:
- 5th intercostal space
- Midaxillary line
- Anterior axillary line
The drain is inserted just above the rib, to avoid the neurovascular bundle that runs below the rib
How does a chest drain work?
One end of the drain is inserted into the chest, and the other is placed in water - this allows air to exit the chest and bubble through the water, but not re-enter the chest
What are the complications of a chest drain?
Air leaks around drain site
Surgical emphysema (air collects in the subcutaneous tissue)
When will a patient require surgical management for a pneumothorax?
A chest drain fails to treat pneumothorax
There is persistent air leak of the drain
The pneumothorax reoccurs
What is the emergency management of a tension pneumothorax?
ABCDE assessment
Give high flow oxygen via a non-rebreather mask
Needle decompression with 14G cannula
Chest drain inserted after aspiration
Repeat CXR
Do not delay treatment by performing investigations
How is needle decompression carried out in tension pnemothorax?
16 gauge cannula, inserted into the fifth intercostal space, mid-axillary line on the affected side
What are the risk factors for primary spontaneous pneumothorax?
Tall, slender, young
Smoking
Marfan syndrome
Rheumatoid arthritis
Family history
Homocystinuria
Diving or flying
What are the risk factors for tension pneumothorax?
Mechanical ventilation
Traumatic chest injury
Iatrogenic - central line, lung biopsy
When can patients fly post pneumothorax?
Patients can fly 1 week post-check CXR (if pneumothorax has resolved)
What are the complications of pneumothorax?
Re-expansion pulmonary oedema
Cardiorespiratory arrest
Recurrence
