Pneumothorax Flashcards
What is the typical presentation of a Pneumothorax?
No symptoms OR
Sudden onset of dyspnoea and/or pleuritic chest pain
What are the causes/risk factors for a Pneumothorax?
Spontaneous - rupture of sub pleural bulla Asthma/COPD Resp. infections Carcinoma Fibrosis Connective tissue disorders Trauma Iatrogenic
What is a tension pneumothorax?
Air in the pleural space leading to cardiac compromise
- valvular mechanism allows air into pleural space
- high intrapleural pressure deflates lung & decreases venous return
What is a pneumothorax?
Abnormal collection of air in the pleural space
What are the clinical features of a tension pneumothorax?
Severe symptoms/signs of respiratory distress
- dyspnoea
- laboured ventilation
- decreased sats
- deviated trachea
What are the signs of a Pneumothorax?
Reduced expansion Hyper-resonance Diminished breath sounds (on affected side) Trachea deviated away (tension)
How should a patient with a suspected Pneumothorax be investigated?
CXR
Ultrasound
ABG
What is the emergency treatment for a tension pneumothorax?
Emergency decompression -large bore needle in 2nd ics, midclavicular line 100% O2 CXR Insert chest drain
What are the treatment options for a pneumothorax?
Air rim <2cm & patient not SOB
-Discharge, avoid exercise, interval CXR every 2 weeks, quit smoking
Air rim >2cm & patient SOB
-Attempt aspiration, admit for 24h, insert chest drain
Describe the procedure of aspirating a pneumothorax
Insert 16G cannula into 2nd ics, mid-clavicular line, attach to 3-way tap and a 50ml syringe
Stop when resistance felt/pt coughs excessively
Confirm w/ CXR
Describe the procedure of inserting a chest drain?
CXR to confirm location
Insert in safe triangle
Apply 1% lignocaine to pleura
Attach drain via tubing to underwater seal
Where is the safe triangle?
Ant to mid axillary line
4th-6th ics
What advice should be given to pts after a pneumothorax is resolved?
Avoid flying for 6 weeks
Avoid diving permanently
When is surgery indicated?
Recurrent pneumothorax (>2) or prolonged pneumothorax (>5/7)
What surgical options are available for treating penumothorax?
Pleurectomy Talc pleurodesis (if not fit)
