Pneumothorax Flashcards
What is pneumothorax?
Pneumothorax is air within the pleural space
What are causes of pneumothorax?
Spontaneous - young this men due to rupture of sub pleural bulla
Chronic lung disease - asthma, COPD< CF, fibrosis, sarcoidosis
Infection - TB, pneumonia, abscess
Traumatic - iatrogenic: line insertion, pleural aspiration or biopsy
Carcinoma
CT disorder
What are symptoms or pneumothorax?
Can be asymptomatic OR
Sudden onset of dyspnoea and/or pleuritic chest pain.
Sudden deterioration of asthma/COPD
What are signs of pneumothorax??
Reduced expansion, hyper-resonance to percussion, diminished breath sounds on affected side
With tension pneumothorax, trachea will be deviated away from affected side.
What investigations in pneumothorax?
If tension - immediate treatment
Otherwise
CXR - area devoid of lung markings, peripheral to age of collapsed lung.
ABG in dyspnoeic/hypoxic/chronic lung disease patients
What is seen on x-ray in pneumothorax? Tension pneumothorax?
area devoid of lung markings, peripheral to age of collapsed lung.
Tracheal deviation away from affected side if tension pneumothorax
What are primary/secondary pneumothorax?
Primary if there is no underlying lung disease
Secondary if underlying lung disease or smoker > 50 years old
What is management of primary pneumothorax. What advice to patients?
If the rim of air is < 2cm and the patient is not short of breath then discharge should be considered and review in 2-4 weeks.
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
Pneumothorax due to trauma or mechanical ventilation requires chest drain.
What is management of secondary pneumothorax?
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
What is tension pneumothorax?
Air drawn into the pleural space with each inspiration has no route of escape during expiration.
Mediastinum is pushed over to contralateral hemithorax, compressing great veins.
Cardioresp arrest will occur unless air is removed
What are signs of tension pneumothorax?
REspiratory distress
Tachycardia
Hypotension
Distended neck veins
Trachea deviated away from side of pneumothorax
Increased percussion note
Reduced air entry/breath sounds on affected side
What is treatment of tension pneumothorax
Insert a large bore (14G/16G) needle with syringe partially filled with 0.9% saline into the 2nd intercostal space midclavicular line on side of pneumothorax.
Remove plunger and allow trapped air to bubble through the syringe until a chest tube can be placed.
Then insert a chest drain and request CXR
