Pneumothorax Flashcards
What is a pneumothorax?
A pathological collection of air in the pleural space between the lung and the chest wall.
What are the symptoms of a pneumothorax?
Typically acute
Dyspnoea Chest pain: often pleuritic Sweating Tachypnoea Tachycardia
What are risk factors for a pneumothorax?
Pre-existing lung disease: COPD, asthma, cystic fibrosis, lung cancer, Pneumocystis pneumonia
Connective tissue disease: Marfan’s syndrome, rheumatoid arthritis
Ventilation, including non-invasive ventilation
Catamenial pneumothorax (endometriosis within the thorax)
Smoking
What is the treatment of a primary pneumothorax?
Discharge (if small and asymptomatic)
Aspiration
Chest drain ( if > 2cm after aspiration)
Smoking cessation
What is the treatment of a secondary pneumothorax (underlying lung disease)?
Chest drain Aspiration Oxygen and admit if <1cm Scuba diving avoided Smoking cessation
Which patients with iatrogenic pneumothorax will require a chest drain?
Most will resolve with observation
Ventilated patients need chest drains as may COPD patients
How does a tension pneumothorax develop?
May occur following thoracic trauma when a lung parenchymal flap is created, this acts as a one way valve and allows pressure to rise
What are the signs of a tension pneumothorax?
The trachea shifts and hyper-resonance is apparent on the affected side
What is the treatment of tension pneumothorax?
Treatment is with needle decompression and chest tube insertion
What is the transfer factor?
Describes the rate at which a gas will diffuse from alveoli into the blood. Carbon monoxide is used to test the rate of diffusion.
How is the result of transfer factor given?
TLCO or transfer coefficient, KCO
What are the causes of a raised TLCO?
Asthma Pulmonary haemorrhage (Wegener's, Goodpasture's) Left-to-right cardiac shunts Polycythaemia Hyperkinetic states Male gender, exercise
What are the causes of a lower TLCO?
Pulmonary fibrosis Pneumonia Pulmonary emboli Pulmonary oedema Emphysema Anaemia Low cardiac output
What sign on ventilation can be indicative of a tension pneumothorax?
Sudden deterioration with ventilation suggests tension pneumothorax
