Pneumothorax Flashcards
What is a pneumothorax?
Occurs when air gets access to and accumulates in the pleural space
What are the different types of pneumothorax?
- Open (air gets in through open chest wound)
- Closed
- Traumatic
- Non traumatic
BOTH TRAUMATIC AND NON-TRAUMATIC PNEUMOTHORAX CAN RESULT IN TENSION PNEUMOTHORAX
What are the clinical features of a tension pneumothorax?
- Reduced chest expansion
- Hyper-resonant chest on percussion
- Decreased breath sounds
- Dyspnoea
- Trachea and mediastinal shift away from the affected side
- Tachycardia
- Hypotension
- Pleuritic chest pain
Why is tension pneumothorax life threatening?
- Causes cardiopulmonary failure
- The lung collapses and pushing AWAY FROM AFFECTED SIDE against the heart
- Excessive pressure on the heart
What is the emergency management of tension pneumothorax?
- Insert a large bore needle (14G) into the 2nd intercostal space mid-clavicular line
- Retrieve the plunger to collect the remaining air
Do this before requesting an X-ray
Then insert a chest drain
What is the difference between an aspiration and chest drain?
- Aspiration involves a much thinner needle
- Carried out before chest drain
- If unsuccessful, chest drain considered
What are the symptoms and signs of a pneumothorax (not tension)
- Pleuritic chest pain
- Dyspnoea
- Sudden detoriation of asthma or COPD
- Hypoxia
- Reduced expansion and hyper-resonance to percussion
TENSION PNEUMOTHORAX causes problems with the heart where as a normal pneumothorax is not as severe and so may not
A small pneumothorax may be asymptomatic
What is pleuritic chest pain?
Characterised by sudden, intense, sharp, stabbing or burning pain in the chest when inhaling or exhaling
What are the 6 main causes of pleuritic chest pain?
- Pulmonary Embolism
- Pericarditis
- MI
- Pneumothorax
- Pneumonia
- Aortic Dissection
Pain that worsens when lying down is often associated with pericarditis
Hypotension and widened pulse point towards aortic dissection
What are the causes of pneumothorax?
Non traumatic pneumothorax can occur spontaneously (primary) or due to underlying lung disease (secondary)
- Underlying lung diseases include:
Asthma COPD Respiratory infection TB Cystic fibrosis Lung fibrosis Sarcoidosis
Traumatic pneumothorax occurs as a result of sudden or blunt injury
What is the pathophysiology of Pneumothorax?
- Air enters the pleural space resulting in the -ve pressure turning more +ve
- Lungs are therefore unable to expand as much
- Tension pneumothorax occurs when lungs are under so much pressure that they get pushed away from the affected side causing tracheal deviation
- Lungs push against the heart, decreasing BP
What are the investigations in suspected pneumothorax?
- CXR (first line)
- CT
- Ultrasound
- Bronchoscopy
- ABG (should show hypoxia)
What is the differential diagnosis of pneumothorax?
- Acute exacerbation of asthma
- Acute exacerbation of COPD
- Large bullae in COPD
- Pulmonary Embolism
- MI
What is the management of primary pneumothorax?
=> Is patient presenting with DYSPNOEA OR a rim of air greater than 2cm on CXR?
- If YES, do aspiration
- If NO, consider discharge and outpatient review in 24h
If aspiration is successful consider discharge
If aspiration unsuccessful, do CHEST DRAIN
What is the management of secondary pneumothorax?
=> Is the patient presenting with DYSPNOEA OR a rim of air on CXR greater than 2cm?
- If YES, CHEST DRAIN immediately
- If NO, is the size 1-2cm?
=> Size is 1-2cm
- ASPIRATION. If aspiration successful, admit for 24h observation and oxygen
- If aspiration unsuccessful, do chest drain
=> Size is less than 1cm
- Observation and oxygen for 24h
