Pneumothorax Flashcards
What is a pneumothorax?
A collection of air in the pleural space
What is the difference between primary and secondary spontaneous pneumothorax?
Primary - young people without known respiratory illness
Secondary - patients with pre-existing pulmonary diseases
What is a tension pneumothorax?
Air escapes from the lung through a one-way valve and cannot escape the pleural space so pressure builds up and can shift structures out of their normal position
What are some causes of tension pneumothorax?
Rupture of sub-pleural bullae Ventilated patient Trauma Blocked, kinked or misplaced drain Pre-existing respiratory disease
What are risk factors for pneumothorax?
Cigarette or cannabis smoking Tall and slender body build Connective tissue disease e.g. Marfan's Recent invasive medical procedure Chest trauma Pre-existing lung disease
What are the symptoms of pneumothorax?
Pleuritic chest pain
May be shoulder tip pain
Dyspnoea
What are signs of pneumothorax?
Hyperresonance Tachycardia Reduced expansion Hamman's sign (click on auscultation on the left side) Quiet breath sounds
What are signs of a tension pneumothorax?
Trachea shifted to the opposite side from the pneumothorax
Hypotension
Raised JVP
Reduced air entry on affected side
What are the investigations for pneumothorax?
CXR
Blood tests
ABGs
What is seen on CXR in a pneumothorax?
Visible rim between lung margin and chest wall
Absence of lung markings
Trachea deviated in tension pneumothorax
What is the treatment for a tension pneumothorax?
Immediate decompression with a large bore cannula through the 2nd intercostal space in the mid-clavicular line
If secondary trauma do open thoracostomy
High flow oxygen
Chest drain
What is the treatment for a large non-tension pneumothorax?
Percutaneous aspiration through the 4th/5th intercostal space in the midaxillary line
Chest drain
Oxygen
What is the treatment for a small non-tension pneumothorax?
Observation and oxygen
What is classed as a large and small pneumothorax?
Large - visible rim >2cm between lung margin and chest wall
Small - rim <2cm
What lifestyle measures can be taken to prevent recurrence?
No diving
No air travel for 1 week
Smoking cessation
