Pneumothorax Flashcards
What is a pneumothorax?
What is the difference between primary & secodary pneumothorax?
What is a tension pneumothorax?
Abnormal collection of air or gas in the pleural space that separates the lung from the chest wall.
Primary - no apparent cause & absence of significant lung disease
Secondary - presence of existing lung pathology
Tension - Air drawn into plrual space with each inspiration has no route of excape during expiration. Mediastinum is pushed over into contralateral hemithorax, kinking & compressing great veins. Causing cardiorespiratory arrest if not treated.
What can cause a pneumothorax?
Primary spontaneous;
- Young thin men
- Due to rupture of sub-pleural bulla (air-filled lesions under pleural surface)
Secondary;
- Asthma, COPD, Lung/ cystic fibrosis
- TB, Pneumonia, Sarcoidosis
- Lung abscess, Carcinoma
Any pneumothorax can cause a Tension pneumothorax
What are the sympyomts & signs of a pneumothorax?
Symptoms;
- None (fit, young ppl or small pneumothorax)
- Or sudden onset;
- Dyspnoea
- Pleuritic chest pain
- Sudden deterioration in asthma, COPD
Signs;
- ↓ expansion & breath sounds
- ↑ per-resonance to percussion
- Tension pneumothorax also has;
- Trachia deviated away from pneumothorax
- Respiratory distress
- ↓BP, ↑HR, ↑JVP (distended neck veins)
How would you investigate a pneumothorax?
- PA CXR
- Measure interplerual (rim) distance at level of hilum
- If unclear, do lateral (decubitus)
- If obscured by surgical emphysema/ complex bulla disease CT may help
How would you treat a pneumothorax?
Primary pneumothorax;
- Rim >=2cm or breathless?
- Yes - aspirate
- No - observe for 4hr & follow-up
- Rim <=1cm, breathing better?
- No - intercostal tube drainage
- Yes - observe for 4hr & follow-up
Secondary pneumothorax;
- Rim >=2cm or breathless?
- Yes - intercostal tube drainage
- No - → 2
- Rim of air >1cm?
- Yes - aspirate and (→3)
- No - in-patient observation (→3)
- Rim <1cm?
- No - Intercostal tube drainage
- Yes - in-patient observation
If bilateral or haemodynamically unstable proceed to chest drain.