Pneumothorax Flashcards
What is a pneumothorax?
The presence of air within the pleural cavity
What can cause a pneumothorax?
Trauma - stabbing, rib fracture
Iatrogenic- CT guided or trans bronchial lung biopsy, pleural aspiration
Spontaneous
Secondary sponeteous due to underlying respiratory disease
Describe a tension pneumothorax?
A medical emergency where the one way valve leads to an increased intrapleural pressure which impairs venous return, cardiac output and causes hypotension
How is a tension pneumothorax managed in the immediate setting?
Venflon into 2nd intercostal space, midclavicular line to relieve pressure
List the epidemiological risk factors for a spontaneous pneumothorax?
Men
Smoker
Tall height
It is likely that a pneumothorax will recur. T/F?
True - there is a 40-50% of recurrence after the first episode
Describe the development of a primary pneumothorax
Spontaneous rupture of the visceral pleura allows air to flow from the airway to the pleural space down a pressure gradient which results in collapse of the elastic lung.
There is a formation of sub pleural blebs or bull at the lung apex and possible diffuse emphysema below the visceral pleura
What underlying abnormalities can lead to secondary pneumothorax?
Inherent weakness in the lung tissue such as in emphysema
Increased airway pressure such as in asthma or ventilated patients
Increased lung elasticity such as pulmonary fibrosis
Secondary pneumothorax has a better prognosis than primary pneumothorax. T/F?
False. - secondary has a worse prognosis
What are the signs and symptoms of a pneumothorax?
Pleuritic chest pain Breathlessness Respiratory distress Reduced air entry on affected side Hyperresonance to percussion Reduced vocal resonance Tracheal deviation if tension pneumothorax
What are the differential diagnoses of pneumothorax?
Pulmonary thromboembolism
Musculoskeletal pain
Pleurisy/penumonia
Size is more important than symptoms when decide how to manage a pneumothorax. T/F?
False - the opposite is true
What size of a pneumothorax is considered to be large?
> 2cm
If a pneumothorax is small and not very symptomatic, how might it be managed?
Serial CXR for observation
Where would a catheter be inserted to aspirate a pneumothorax?
2nd intercostal space, midclavicular line
When would a chest drain be used to manage a spontaneous pneumothorax?
If pneumothorax >2cm or causes breathlessness
If 16-18G cannula aspiration fails
When would a patient with a pneumothorax be referred to surgery?
If chest drain fails to work in 5 days
What are the possible surgical management strategies for a pneumothorax?
Stapling blebs
Talc pleurodesis
Pleural abrasion/stripping
When, in the management of a pneumothorax, would a surgical pleurodesis be considered?
If a second pneumothorax develops
Professional considerations e.g. airline pilots, scuba divers
How long after recovery from a spontaneous pneumothorax should a patient wait before flying?
7 days or more
How long after recovery from a spontaneous pneumothorax should a patient wait before diving?
The patient should not dive again
