Pneumothorax Flashcards
What is pneumothorax?
A collapsed lung
An abnormal collection of air in the pleural space that causes uncoupling of the lung from the chest wall and lung collapse
What types of pneumothorax are there?
Primary spontaneous
Secondary spontaneous
Traumatic
Tension
Why do primary spontaneous pneumothoraces occur?
Unknown
A ruptured bleb, caused by a congenital defect in the connective tissue of the alveolar wall
What are the risk factors for a primary pneumothorax?
Male sex
Smoking
Family history of pneumothorax
Why do secondary spontaneous pneumothoraces occur?
COPD
Asthma
Cystic fibrosis
Lung infections
Connective tissue diseases
- Ehlers-Danlos
- Marfan’s
Cancer
What sort of trauma causes pneumothorax?
Blunt trauma ( a blow to the chest)
Penetrating injury to the chest wall
Rib fracture where rib punctures lung
Medical procedures: biopsy
Diving: breathing compressed air
What is a tension pneumothorax?
When air is drawn into the pleural space with each inspiration and there is no route out for the air during expiration
The mediastinum is pushed over towards the other lung, which kinks and compresses the great veins
Cardiorespiratory arrest occurs unless the air is drained immediately
What are the clinical features of pneumothorax?
Sometimes asymptomatic
Sudden onset dyspnoea and pleuritic chest pain
Reduced lung expansion
Hyper-resonance to percussion
Diminished breath sounds on that side
Tracheal deviation away from side of pneumothorax (towards good side)
Investigations for pneumothorax?
Should diagnose clinically
CXR: any areas devoid of lung markings (black) could mean pneumothorax
ABG: in hypoxic patients
What should you be sure to exclude when looking at a CXR?
A large emphysematous bulla
What is a bulla?
Latin for bubble
Air pocket
When should you skip the x-ray and go straight to treatment?
If you suspect a tension pneumothorax
How do you manage a non-tension pneumothorax?
Primary:
- if air < 2cm discharge, stop smoking, never go diving
- if air > 2cm chest drain
Secondary:
- if 1-2cm aspirate air, if doesn’t work chest drain
- if > 2cm chest drain
- treat underlying cause
Management of tension pneumothorax?
Large bore cannula into 2nd ICS MCL
Then chest drain
