pneumothorax Flashcards

1
Q

definition

A

= accumulation of air in pleural spcae with 2ry lung collapse

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2
Q

how is it classified

A

closed- intact chest wall + air leaks from lung into pleural cavity

open- defect in chest wall allow communication between peumothrax + exterior- may be sucking

simple- non expanding collection of air around lung. no shift of heart or mediastinal structures.

tension- air enters pleural cavity via one way valve due to eg. lung laceration + cannot escape=> can get mediastinal compression. pos pressure ventilation may worsen/cause this.

spontaneous [non traumatic] -can be 1ry/2ry

traumatic - can be iatrogenic/accidental

  • iatrogenic= invasive medical procedures eg. CV cannulation, pleural tap or biopsy, FNA, liver biopsy
  • accidental- direct chest wall injury/laceration/fractured ribs
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3
Q

3 overall causes of pneumothorax

A

spontaneous

trauma

iatrogenic

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4
Q

spontaneous causes of pneumothorax

A

spontaneous 1ry

= no underlying lung disease

young thin men [ruptured subpleural bulla], smokers.

spontaneous 2ry

​= underlying lung disease eg

COPD

marfans, ehler’s danlos

Pulm fibrosis, sarcoidosis

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5
Q

trauma causes of pneumothorax

A

penetrating

blunt injury

rib fractures

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6
Q

iatrogenic causes of pneumothorax

A

subclavian CVP line insertion

pos pressure ventilation

transbronchial biopsy

liver biopsy

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7
Q

s/s

A

symptoms

  • sudden onset
  • dyspnoea
  • pleuritic chest pain
  • tension- resp distress, cardiac arrest

signs

  • chest: [VERB}
    • decreased expansion
    • resonant percussion
    • decreased breath sounds
    • decreased VR
  • tension: high JVP, mediastinal shift, high HR, low BP
  • crepitus: surgical emphysema
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8
Q

ix

A
  1. ABG: HYPOXIA
  • hypoxaemia is greater in cases of SSP
  • not required if the oxygen saturations are adequate (>92%) on breathing
  1. US =specific features on ultrasound scanning are diagnostic of pneumothorax but is mainly used in the management of supine trauma patients
  2. CXR
  • presence of a white visceral pleural line separated from the parietal pleura and chest wall by a collection of gas, resulting in a loss of lung markings in this space is a hallmark of the condition
  • mediastinal shift away from pneumothorax
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9
Q

tension pneumothorax mx

A
  1. reuscitate pt
  2. no cxr
  3. large bore venflon [cannula] intro 2nd ics mid clavic line
  4. insert intercostal chest drain [ICD]
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10
Q

traumatic pneumothorax mx

A
  1. reuscitate pt
  2. analgesia- morphine
  3. 3 sided wet dressing if sucking [acts as a flap valve]

= air allowed to escape from ptx during expo but to not enter on inspo

  1. now immediately place ICD!
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11
Q

1ry/2ry spontaneous pneumothorax mx

A

Primary pneumothorax

Recommendations include:

  • if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
  • otherwise aspiration should be attempted
  • if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
  • patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men

Secondary pneumothorax

Recommendations include:

  • if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
  • otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
  • if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
  • regarding scuba diving, the BTS guidelines state: ‘Diving should be permanently avoided unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively.’
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