Pneumothorax

Question 1

What are the different causes of pneumothorax?

Answer 1

Spontaneous - primary (tall thin males) or secondary (pre existing lung disease)
Non-spontaneous = iatrogenic (pleural aspiration/biopsy, lung/liver/breast biopsy, sub Flavian Bevin cannulation, acupuncture)or Non iatrogenic (penetrating I.e. stab or blunt I.e. gut shot , chest wound)

Question 2

How does a tension pneumothorax occur?

Answer 2

Gap in the chest wall creates a flap which acts as a one way valve.
Air gets in but doesn’t get out.
As the air inside the pleural cavity builds up this compresses the lung severely causing the mediastinum to shift.

Question 3

What are the signs of a pneumothorax?

Answer 3

Non if it is small (if they are fit and have respiratory reserve)
On affected side- absent/decreased breath sounds, decreased expansion, hyper resonant and trachea deviated to affected side

Tension pneumothorax - haemodynamic compromise, trachea deviated away from affected side, increased jugular venous pressure. Usually are clamy, sweaty and cyanotic.

Question 4

What are the symptoms of a pneumothorax?

Answer 4

Asymptomatic if its small
Acute or worsening breathlessness
Pleuritic chest pain
Extreme dyspnoea = tension?

Question 5

Describe briefly the treatments of pneumothorax‘s.

Answer 5

Primary non breathless = observe for 24 hrs then CXR to confirm no change
Primary breathless = aspirate pnuemothorax, observe 24hrs then CXR
Secondary breathless = 4 intercostal space mid axillary line chest drain for 1-2 days, then re CXR
Tension = 2nd intercostal space mid clavicular line cannulation (large grey venflon) , insert intercostal chest drain

Question 6

Describe in detail the treatment for a patient who is breathless and has a secondary pneumothorax.

Answer 6

Insert intercostal chest drain
Lung inflates within 1-2 days
Clamp drain for 24hrs, re CXR, if there is no change then remove drain

Question 7

Describe in detail the treatment for a patient who has a primary pneumothorax but isn’t breathless.

Answer 7

Observe overnight and repeat CXR
If no change then the hole has sealed therefore discharge.
Pneumothorax resolves 1.25% per day so review in 2 weeks at clinic

Question 8

Describe in detail the treatment for a patient who has a primary pneumothorax and is breathless.

Answer 8

Aspirate pneumothorax
Patient at 45 degrees, lignocaine to 2nd intercostal space midclavicular line
50ml syringe, venflon, 3 way tap and tube to water
Aspirate until you feel the lung surface on the tip of the venflon which is just under the surface of the chest wall.
If aspirating >3l then this indicates there is an air leak
If successful , re CXR and observe 24 hrs
If unsuccessful then chest drain

Question 9

When would you refer someone for a pleurodhesis?

Answer 9

2nd ipsilateral pneumothorax
1st contralateral pneumothorax
Spontaneous bilateral pneumothoraces
1st pneumothorax in high risk profession

Question 10

what s surgical emphysema?

Answer 10

air trapping in subcutaneous fat

like bubble wrap

Question 11

what is the most common cause of a primary pneumothorax?

Answer 11

usually occur in tall men because the weight of the lung causes apical blebs to develop which rupture.

Question 12

with what type of pneumothorax is the trachea deviated away from the affected side?

Answer 12

tension pneumothorax

Question 13

with what type of pneumothorax s the trachea deviated to the affected side?

Answer 13

non-tension pneumothorax

Question 14

if there is a significant air leak, what can this cause?

Answer 14

surgical emphysema

Question 15

what is the time frame for a spontaneous pneumothorax resolving itself?

Answer 15

1.25% / day