Pneumothorax Flashcards
Define:
Air in the pleural space
Aetiology:
Spontaneous:
- in a healthy lung
- usually in a tall thin man
- due to rupture of the subpleural bleb
Secondary:
-In a lung with previous lung disease such as COPD, asthma, sarcoidosis and TB
Tension:
-Due to lung injury (this is an emergency)
Traumatic:
-penetrating object (often iatrogenic)
Usually the lung tends to recoil inwards but when there is a pneumothorax there is a negative pressure causing it to recoil out and this is what causes the issues
Epidemiology:
9/100,000 a year
20-40 year olds mainly
4x more likely in males
Risk factors:
Male
Previous lung disease
Smoking
Marfans and Ehler’s Danos (collagen disorders)
Symptoms:
if it is small there may be no symptoms
Sudden onset breathlessness
Distress with rapid shallow breathing in a tension pneuthmothorax
Hypoxia or increased ventilation pressure in those on ventilation
Signs:
may be none if it is small
Signs of resp distress
Hyper-resonance, decreased lung expansion and breath sounds on the affected side
Tension - severe resp distress, tachycardia, hypotension, cyanosis, distended neck veins, tracheal deviation away from the affected side
Investigations:
CXR - this will show a dark area with no vascular markings. fluid level and may show tracheal deviation away from the affected side
DO NOT DO CXR IF SUSPICION OF TENSION AS THIS DELAYS TREATMENT
ABG (hypoxemia)
Management:
Tension is an emergency:
- max o2
- needle decompression
- 2.5L of air aspirated
- stop if there is resistance or a cough
- CXR 2hrs later and 2 weeks later
First try aspiration if this fails then chest strain with underwater (also use after a tension pneumo treatment and if there is fluid in the pleural space)
If recurrent - chemical pleurodesis or surgical pleurectomy
Complications:
recurrent pneumothoracies
Bronchopulmonary fistula
Re-expansion pulmonary oedema
prognosis:
those who have one have a 20% likelyhood of having another
the greater the frequency the great the number of pneumothoracies.
