Pneumothorax Flashcards
What is a pneumothorax
A collection of air in the pleural space
What is a spontaneous pneumothorax
They occur in individuals without a background of underlying lung disease. More common in the younger population
Usually due to rupture of subpleural blebs at the apex
What is a secondary pneumothorax
It occurs on the background of an underlying lung disease such as COPD or CF
What is a traumatic pneumothorax
Following a penetrating chest wound
What is an iatrogenic pneumothorax
Due to invasive chest procedures eg. ventilation, central line placement, lung/pleural biopsy or pleural aspiration
What are some risk factors for developing a pneumothorax
Tall, thin man
Smoking - significant risk factor
Genetic disorders eg. Marfans
How would a patient with a pneumothorax present
Sudden onset breathlessness
Acute pleuritic pain
What signs would you expect to find on examination of a patient with a pneumothorax
Increased resp rate Reduced breath sounds Hyper-resonance Reduced chest expansion on affected side Reduced vocal resonance on affected side
*Trachea and apex may be deviated to opposite side in tension pneumothorax
What causes a tension pneumothorax
Positive pressure gradient within the pleural space - air flowing into the pleural space but unable to flow out
How do you treat a tension pneumothorax
18G cannula into the 2nd intercostal space, mid-clavicular line on the affected side
Needs urgent chest drain insertion after pressure relieved
Where is a chest drain inserted
5th intercostal space, anterior axillary line. In the “safe triangle”
What are the borders of the safe triangle
Anterior border of the latissimus dorsi
Lateral border of the pectoralis major
Line superior to the horizontal level of the nipple
How would you manage a pneumothorax
Less than 2cm rim of air and asymptomatic - manage with early outpatient review
If over 2cm or symptomatic - admit to hospital for simple aspiration (repeat if unsuccessful)
*Put patient on 10L O2 if admitted
How do you aspirate a simple pneumothorax
16G cannula 2nd intercostal space mid-clavicular line, connected to a syringe
*If over 2.5L air aspirated, abandon aspiration as indicates persistent leak
How much oxygen would you put a pneumothorax patient on if admitting them into hospital
High flow - 10L
