Pneumothorax Flashcards
what is a pneumothorax?
Collection of air in the pleural space resulting in a collapsed lung
what are the causes of pneumothorax in adults ?
primary
secondary
marfans syndrome
can be caused by iatrogenic causes and trauma
what are the primary causes?
normal lungs then apical bullae rupture
what are the secondary causes?
pre-existing lung disease e.g. smoking, severe asthma, COPD
what is marfans syndrome?
a hereditary disorder of connective tissue, resulting in abnormally long and thin digits and also frequently in optical and cardiovascular defects.
what are some of the causes of pneumothorax in children?
Increased incidence with intermittent positive pressure ventilation (IPPV), Continuous positive airway pressure (CPAP) and ventilation
other risk factors - RDS (stiff lungs)
maybe because of problems with ventilation following RDS. Over- inflation of lungs
what are the symptoms of pneumothorax?
sudden onset pleuritic pain, shortness of breath and tachycardia
there may be no symptoms especially if young and fit
what are the symptoms of pneumothorax on a mechanically ventilated patient?
may present with hypoxia or an increase in ventilation pressures
what are some signs of pneumothorax?
Tachycardia Hyper-resonant percussion note reduced expansion quiet breath sounds on auscultation Hamman’s sign ( click on auscultation at left side ) pallor
what investigations should be done/
CXR
ABG - to see if they are hypoxic
CT chest
what may be seen on CXR?
CXR: collapsed lung and a sharpened defined edge of the deflated lung
may see mediastinal shift
small if 2cm
why is a CT useful?
useful to differentiate bullous lung disease
what is the treatment ?
Oxygen if there is no drain in
needle aspiration (2nd Intercostal space, mid-clavicular line)
chest drain if recurs using large bore cannula into the 5th mid-axillary line
if it is asymptomatic and small - no treatment is needed
maybe surgical intervention needed
why may surgery be needed?
2nd ipsilateral ptx
1st contralateral ptx
bilateral spontaneous ptx
spontaneous haemothorax
if there has been > 5 days of persistent air leak (drainage)
if it’s the 1st ptx of someone with a high risk occupation - e.g. diving or flying
what can a tension pneumothorax lead to?
can lead to cardiac arrest due to one-way valve mechanism (between pleural layers) resulting in increasing pressure in pleural space
acute respiratory distress
