Pneumothorax Flashcards
What is pneumothorax?
Pneumothorax occurs when air gets into the pleural space, separating the lung from the chest wall.
What are the typical patient characteristics for pneumothorax?
Tall, thin young man presenting with sudden breathlessness and pleuritic chest pain.
What are the aetiologies of pneumothorax?
- spontaneous
- trauma
- iatrogenic (e.g. lung biopsy, mechanical ventilation, central line insertion)
- lung pathologies (e.g. infection, asthma, COPD)
What is the first choice investigation for simple pneumothorax?
Erect chest x-ray
How is the size of pneumothorax measured according to BTS guidelines 2010?
Measure horizontally from lung edge to inside of chest wall at level of hilum.
What is the management for pneumothorax with no shortness of breath and <2cm rim of air on CXR?
- No treatment, will resolve spontaneously
- Follow-up in 2-4 weeks
What is the management for pneumothorax with shortness of breath or >2cm rim of air on CXR?
- Aspiration followed by reassessment
- Failed aspiration twice ⇒ chest drain
What management is required for unstable patients, bilateral, or secondary pneumothoraces?
Usually require a chest drain.
Where is a chest drain inserted?
Into the ‘triangle of safety’ formed by:
* 5th intercostal space
* midaxillary line (latissimus dorsi)
* anterior axillary line (pectoralis major)
What is the purpose of inserting the needle just above the rib during chest drain insertion?
To avoid the neurovascular bundle.
What are some complications of chest drain insertion?
- Air leaks around drain site
- Surgical emphysema
When is surgical management indicated for pneumothorax?
- Chest drain fails to correct pneumothorax
- Persistent air leak in drain
- Pneumothorax reoccurs
What is the technique used in surgical management of pneumothorax?
Video-assisted thoracoscopic surgery (VATS)
What is pleurodesis?
Creating inflammatory reaction in pleural lining so that pleura stick together, sealing pleural space.
What are the types of pleurodesis?
- Abrasive pleurodesis (direct physical irritation)
- Chemical pleurodesis (using chemicals, such as talc powder, to irritate pleura)
What is pleurectomy?
Removal of the pleura.
What causes tension pneumothorax?
Trauma to chest wall, creating a one-way valve.
What are the clinical features of tension pneumothorax?
- Tracheal deviation away from side of pneumothorax
- Reduced air entry on affected side
- Increased resonance to percussion on affected side
- Tachycardia
- Hypotension
What is the immediate management for tension pneumothorax?
Insert a large bore cannula into the second intercostal space in midclavicular line.
What is the definitive management for tension pneumothorax?
Chest drain.
