Pneumothorax Flashcards

1
Q

What is a pneumothorax?

What is the difference between primary & secodary pneumothorax?

What is a tension pneumothorax?

A

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.

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2
Q

What can cause a pneumothorax?

A

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

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3
Q

What are the sympyomts & signs of a pneumothorax?

A

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)
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4
Q

How would you investigate a pneumothorax?

A
  • 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
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5
Q

How would you treat a pneumothorax?

A

Primary pneumothorax;

  1. Rim >=2cm or breathless?
    • Yes - aspirate
    • No - observe for 4hr & follow-up
  2. Rim <=1cm, breathing better?
    • No - intercostal tube drainage
    • Yes - observe for 4hr & follow-up

Secondary pneumothorax;

  1. Rim >=2cm or breathless?
    • Yes - intercostal tube drainage
    • No - → 2
  2. Rim of air >1cm?
    • Yes - aspirate and (→3)
    • No - in-patient observation (→3)
  3. Rim <1cm?
    • No - Intercostal tube drainage
    • Yes - in-patient observation

If bilateral or haemodynamically unstable proceed to chest drain.

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