Pneumothorax Flashcards
Define pneumothorax
Air in the pleural space with secondary lung collapse
there are some other variants:
- haemothorax - blood
- chylothorax - lymph
They can be open, closed or tension
Open: defect in chest wall allows comm of PTX with exterior - sucking
Closed: intact chest wall, air leaks from lung to pleural cavity
Tension: air enters pleural cavity through 1 way valve and cannot escape -> shift
Explain the aetiology/ risk factors of pneumothorax
SPONTANEOUS:
- normal lungs
- tall, thin male smokers
- rupture of subpleural bleb
SECONDARY:
- pre-existing lung disease (COPD, asthma, TB, fibrosis, sarcoidosis)
TRAUMA:
- penetrating injuries to the chest
- blunt ± ribs #s
IATROGENIC:
- positive pressure ventilation
- central lines
- liver biopsies
- thoracocentesis, pleural tap
Risk factors:
- Collagen disorders (Marfan’s, Ehlers-Danlos)
- Males
- Smokers
- <40
- FH
Summarise the epidemiology of pneumothorax
Annual incidence 0,09%
UNCOMMON
Males:females 4:1
20-40 year-olds
Recognise the presenting symptoms of pneumothorax
- May be ASYMPTOMATIC if small
- Sudden onset SOB
- Pleuritic chest pain
- Distress with rapid shallow breathing in tension
- ± cardiac arrest
Recognise the signs of pneumothorax
There may be no signs if small
Signs of resp distress (tachypn, tachy, colour changes, wheeze)
Auscultation:
- reduced expansion
- hyper-resonant on percussion
- reduced breath sounds
- decreased vocal resonance
Tension pneumothorax:
- severe resp distress
- tachy
- hTN
- cyanosis
- raised JVP
- tracheal deviation away from side of the pneumothorax
- ±crepitus - surgical emphysema
Identify the appropriate investigations for pneumothorax
CXR:
- translucency
- surgical emphysema
- rib fractures
- mediastinal shift
- bullaes
- fluid level may be seen if bleeding
ABG: check for hypoxaemia
Generate a management plan for pneumothorax
Tension pneumothorax (EMERGENCY):
- Maximum O2
- insert large bore needle into 2ICS MCL
- up to 2.5L of air can be aspirated
- F/U CXR 2hours and 2 weeks later
Chest drain with uderwater seal:
- is aspiration fails
- if fluid in pleural space
- after decompression of tension penumothorax
- 4-6th ICD MAL
Other: analgesia, 3-sided occlusive dressing for sucking
Recurrent pneumothorax:
- chemical pleurodesis of visceral and parietal with tetracycline or calcium
- suregical pleurectomy
No plane travel for 2 weeks/ diving
Identify the possible complications of pneumothorax
Recurrent pneumothoraces
Bronchopleural fistula
Summarise the prognosis for patients with pneumothorax
30-50% will have another one
Frequency increases with repeated pneumothoraces
