Pneumothorax Flashcards
What is a pneumothorax and what are the different types?
Air in the pleural space.
Primary spontaneous (otherwise healthy individual)
Secondary spontaneous (underlying lung pathology)
Traumatic
Tension (Causes tracheal deviation away from the pneumothorax)
Describe the clinical presentation of a pneumothorax?
Pleuritic pain
SOB
Haemoptysis
However it is often assymptomatic 2/3.
In a tension pneumothorax patients will be more shocked. There will be tracheal deviation and more marked hyperesonance and reduced breath sounds.
What is the pathology underlying a tension pneumothorax?
It is a medical emergency as it is causing compression of mediastinal structures, aka the IVC it can therefore stop venous return to the heart causing cardiogenic shock.
What are the risk factors for developing a pneumothorax?
Primary pneumothorax:
Tall patients
Marfans
Smoking
Presence of sub pleural blebs
Secondary pneumothorax:
Various underlying lung conditions, including COPD, tuberculosis, sarcoidosis, cystic fibrosis, malignancy, and idiopathic pulmonary fibrosis.
FH of pneumothoraces
What findings would you expect to see o/e?
Tacypnoea
Reduced unilateral chest expansion
Hyperesonant
Reduced or absent breath sounds
What investigations would you do, and how would you treat an emergency tension pneumothorax?
O2 sats
Bloods: FBC UEs LFTs CRP ABG
Rule out other causes
Imaging:
CXR (shouldn’t wait for this if you suspect a tension pneumothorax)
Treatment of tension pneumothorax:
Large bore needle in second intercostal space mid clavicular line. After this a CXR should be taken and a chest drain should be inserted.
What is the management for a simple pneumothorax?
A chest drain should be inserted depending on the size of the pneumothorax.
If it is greater than 2cm then the pneumothorax should be aspirated if it is a primary pneumothorax or a chest drain should be inserted if it is a secondary pneumothorax.
If the pneumothorax hasn’t resolved after aspiration with a cannula then a chest drain should be considered.
What is pleurectomy and pleurodesis?
It is a key hole thoracic’s surgical procedure in which par of the pleura is removed (pleurectomy) and the lung is attached down to the chest wall.
Pleurodesis is when a sclerosing agent is used to adhere the 2 pleura and eliminate the pleural space
What are the indications of pleurectomy and pleurodesis?
2 or more spontaneous pneumothoraces.
A traumatic pneumothorax.
