PNEUMOTHORAX Flashcards
Causes of spontaneous pneumothorax?
Secondary
- COPD
- ASTHMA
- PE
- CF
Traumatic - penetrating or blunt
Iatrogenic - mechanical ventilation, CVC insertion, thoracocentesis, lung biopsy
What are the broad causes of pneumothorax?
Primary
Secondary (usually resp related)
Iatrogenic
Traumatic
What is a tension pneumothorax usually due to? How do you treat it?
Usually from trauma, mechanical ventilation and post-CPR.
Urgent needle decompression with 14G cannula in the L 2 ICS
Spontaneous pneumothorax affects what demographic?
Tall, thin men, smoking, FHx.
Rare for death.
Risk factors?
MALE THIN TALL SMOKING ACUTE SEVERE ASTHMA COPD
Symptoms?
Acute onset SOB
Pleuritic Chest pain
+/- obstructive shock
Ix?
CXR
+/- CT chest
Management of pneumothorax?
Context dependent.
Stable:
• Stable with 1st spontaneous pneumothorax 3cm
i. Aspiration (shorter hospitalization, same outcome)
ii. Failing aspiration, chest tube
• Recurrent pneumothorax/concomitant haemothorax: chest tube + thoracoscopy
How do you prevent reoccurrence?
Pleurodesis via video assisted thorascopic surgery (VADS)
Chemical Pleurodesis via tube thoracostomy.
What is Pleurodesis?
Obliteration of the pleural space. Stick the pleura together
What is a chest tube? Where is it inserted?
Tube inserted through chest wall into pleural space that can remove air, fluid or pus from the intrathoracic space.
Inserted into 5th intercostal space, slightly anterior to mid axillary line.
Do you insert the chest tube directly above or below the rib?
The vein artery and nerve (neurovascular bundle) run just under the rib.
Therefore to avoid it you insert just above a rib.
What is aspiration for pneumonia?
Thoracocentesis involves cannula in to drain
What is a pneumothorax? What is a tension pneumothorax
Abnormal collection of air in the pleural space.
In tension there is a one way valve effect. Air goes in can’t come out, you get progressingly more and more air going in. Causing impairment to respiration and blood circulation.
