Pneumothorax Flashcards
what is a pneumothorax
air trapped in the pleural space
what things can cause a pneumothorax
spontaneous - typically a young, thin man
trauma
underlying lung disease - COPD, asthma, infection
connective tissue disease - marfans
iatrogenic - lung biopsy, ventilation, central line insertion
symptoms of pneumothorax
acute onset SOB + pleuritic chest pain
tension pneumothorax – respiratory distress
what is a tension pneumothorax
pneumothorax caused by trauma that creates a one way valve
- lets air in but not out of the pleural space
- more air drawn in with each breath but cannot be exhaled
- creates pressure in the thorax that pushes mediastinum across – can result in cardiorespiratory arrest
signs of a tension pneumothorax
trachea deviated away from affected side
reduced air entry on affected side
hyper-resonant percussion on affected side
tachycardia
hypotension
management of tension pneumothorax
insert large bore cannula into second intercostal space mid-clavicular line to relieve pressure
then definitive management with a chest drain in the 5th intercostal space mid- axillary line
imaging required for a simple pneumothorax
Erect CXR
- will show area between lung and chest wall where there are no lung markings
management of spontaneous pneumothorax <2cm + no SOB
Conservative - will resolve spontaneously
follow up in 2-4 weeks
management of pneumothorax due to underlying cause:
- if <1cm + stable
- if 1-2cm + no SOB
- if > 2cm + SOB
if <1cm + stable = admit for 24 hours + oxygen
if 1-2 cm + no SOB = needle aspiration
if >2cm or SOB = chest drain
what is atelectasis
lung collapse
- common post operatively. Basal alveolar collapse (due to obstruction by bronchial secretions) leads to respiratory difficulty
- suspect in patient with dyspnoea + hyperaemia 72 hours post op
management of atelectasis
position patient upright
chest physio – breathing exercises
