Pneumothorax Flashcards
What is it
air in the pleural space
What are RFs?
smoking fHx tall thin m>f young COPD Marfan syndrome
What is the typical patient?
tall thin young man
What are the sx?
- Can be no sx if small young + fit
- Chest pain (pleuritic)
- Dyspnoea
- Sweating
- Tachypnoea + tachycardia
How can a pt w COPD/asthma present w pneumothorax?
sudden deterioration
What might you find on examination?
Reduced expansion
Hyperresonance to percussion
Diminished breath sounds on affected side
What are the types of pneumothorax?
Closed
Open
Tension
What is the difference between closed and open pneumothorax?
Closed - chest wall remains intact
Open - passage from external environment into pleural space
Explain what a tension pneumothorax is
Thoracic trauma creates a lung parenchymal flap
- > acts as a one way valve so pressure rises
- > trachea shifts and hyper-resonance is apparent on affect side
What is the difference between primary and secondary pneumothorax?
primary - no underlying lung disease
secondary - underlying lung disease
When does a patient w pneumothorax not need treatment?
if rim of air is <2cm and pt isn’t short of breath in primary
consider aspiration
What is the rx of primary P?
if rim of air is <2cm and no SOB:
Observation
If rim of air >2cm and/or SOB:
aspiration then if fails - chest drain
What is the treatment of secondary P?
if >50 and >2cm rim of air and/or SOB - chest drain
otherwise aspiration and then CD if this fails
What is the treatment of secondary P <1cm
give o2 and admit for 24hrs
How do you remove air in tension pneumothorax?
insert large bore needle w syringe partially filled w 0.9% saline into 2nd ICS in midclavicular line on side os P
Remove plunger allow trapped air to bubble through syringe until a chest tube can be placed
Do this BEFORE requesting a CXR
THEN INSERT CHEST DRAIN
