Pneumothorax Flashcards
What is the typical pneumothorax patient?
The typical patient in your exams is a young, tall, thin young man presenting with sudden breathlessness and pleuritic chest pain, possibly whilst playing sports.
What are some causes of a pneumothorax?
Spontaneous
Trauma
Iatrogenic - such as due to lung biopsy, mechanical ventilation or central line insertion
Lung pathology such as infection, asthma or COPD
What is the investigation of choice for a simple pneumothorax?
Erect chest xray is the investigation of choice for a simple pneumothorax. It shows an area between the lung tissue and the chest wall where there are no lung markings. There will be a line demarcating the edge of the lung where the lung markings ends and the pneumothorax begins.
How would you detect a small pneumothorax?
CT thorax can detect a small pneumothorax that is too small to see on a chest xray or be used to accurately assess the size of the pneumothorax
Management if no SOB and there is a < 2cm rim of air on the chest xray?
No treatment required as it will spontaneously resolve. Follow up in 2-4 weeks is recommended.
Management if SOB and/or there is a > 2cm rim of air on the chest xray?
Requires aspiration and reassessment
What is the management if aspiration fails twice?
Chest drain
What is a tension pneumothorax?
Tension pneumothorax is caused by trauma to chest wall that creates a one way valve that lets air in but not out of the pleural space. The one way valve means that during inspiration air is drawn into the pleural space and during expiration the air is trapped in the pleural space. Therefore more air keeps getting drawn into the pleural space with each breath and cannot escape. This is dangerous as it creates pressure inside the thorax that will push the mediastinum across, kink the big vessels in the mediastinum and cause cardiorespiratory arrest.
Signs of tension pneumothorax
Tracheal deviation away from side of pneumothorax
Reduced air entry to affected side.
Increased resonant to percussion on affected side.
Tachycardia.
Hypotension.
What is the management of a tension pneumothorax?
The management sentence you need to learn and recite in your exams is: “Insert a large bore cannula into the second intercostal space in the midclavicular line.”
If a tension pneumothorax is suspected do not wait for any investigations. Once the pressure is relieved with a cannula then a chest drain is required for definitive management.
What is the “triangle of safety” when doing a chest drain?
The 5th intercostal space (or the inferior nipple line)
The mid axillary line (or the lateral edge of the latissimus dorsi)
The anterior axillary line (or the lateral edge of the pectoris major)
What structure is important to avoid when inserting a chest drain?
The needle is inserted just above the rib to avoid the neurovascular bundle that runs just below the rib
What is it important to do after inserting a chest drain?
CXR
What is a bleb?
Congenital defect in the tissue of the alveolar wall.
What is the recurrence rate in primary spontaneous pneumothorax?
Recurrence rate of 25-50% – usually recur within the first year
