Pneumothorax Flashcards
What is a pneumothorax?
Air in the pleural space leading to partial or total collapse of lung
What are causes of pneumothorax?
Spontaneous (especially in young thin men)- rupture of sub-pleural bulla Chest trauma Asthma/ COPD, TB, Pneumonia Lung abscess Carcinoma Cystic fibrosis Lung fibrosis Sarcoidosis
Symptoms of pneumothorax?
Sudden onset of pleuritic chest +- dyspnoea
May be asymptomatic if small
COPD/ Asthma patients may present with a sudden deterioration
Signs of pneumothorax?
Reduced expansion
Hyper-resonance to percussion
Diminished breath sounds on effected side
Trachea will deviate away from the affected side in a tension pneumothorax.
What is the main difference in auscultation between a pneumothorax and a pleural effusion?
Pneumothorax= hyper resonant
Pleural effusion= dull to percussion
Diagnostic tests for a pneumothorax?
CXR will confirm
Dont CXR if a tension pneumothorax as it is a medical emergency
Treatment for pneumothorax?
Aspiration is used in large/symptomatic primary pneumothorax, or small/asypmtomatic secondary pneumothorax. Repeat this if unsuccessful. Then chest drain
Pneumothorax due to trauma or mechanical ventilation needs a chest drain (tube through ribs into pleural space)
Tension pneumothorax pathophysiology?
minority of cases, rare unless px is on mechanical ventilation
Pleural tear acts as a one way valve
Air passes in on inspiration and doest leave on expiration
causes a unilateral increase in pleural pressure–> shock
–> cardiorespiratory arrest
Clinical presentation of a tension pneumothorax?
Respiratory distress: tachycardia, hypotension, distended neck veins, trachea deviation from side of pneumothorax
Increased percussion note, reduced air entry/ breath sounds on the affected side.
Tension pneumothorax is a medical emergency, how is it treated?
To remove air insert a large bore needle into 2nd intercostal space, mid-clavicular line until chest tube can be placed
