Pneumothorax Flashcards
What happens in a pneumothorax?
Air replaces lubricating fluid between the visceral and the parietal pleura.
How is the pleural space maintained?
Pleural space should be a vacuum as determined by a balance of these 2 opposing forces: 1. Muscle tension of the diaphragm and chest wall outwards 2. Elastic recoil of the lungs inwards.
What happens when the pleural space is ruptured?
When pleural space is ruptured, lungs will pull in and collapse and the chest springs out. Collapsed lung means poor gas exchange.
What are the different types of pneumothorax?
- Spontaneous 2. Tension 3. Traumatic
What is a spontaneous pneumothorax?
Subpleural bullae (air pocket) forms on surface of lung and breaks. Bullae forms when alveoli leaks and air seeps into lungs. Bullae break leads to a hole in the visceral pleural and air into the pleural cavity
What is the difference between a primary and secondary spontaneous pneumothorax
• Primary- rupture of bullae occurs in absence of underlying condition • Secondary- occurs in someone with underlying lung disease (cystic fibrosis, Marfans, emphysema)
What is a tension pneumothorax?
one way valve formed by damaged chest wall tissue so air can enter but cannot leave (intrathoracic pressure builds up). Trachea movement can compress heart
What is a traumatic pneumothorax?
Following physical trauma to chest/ as a result of medical procedure (iatrogenic pneumothorax)
What are the risk factors for pneumothorax?
What are the symptoms of a pneumothorax?
*might be asymptomatic if small pneumothorax and patient is young, healthy…
Symptom onset is sudden:
- Dyspnoea
- Pleuritic chest pain
- Sweating
- Tachypnoea
- Tachycardia
- Mechanically ventilated patients might present with hypoxia or an increase in ventilation pressures.
What are the signs of pneumothorax O/E?
What might you see with a tension pneumothorax
- Tracheal deviation away from the affected lung
- Respiratory distress
- Hypotension
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What investigations do you want to do for a pneumothorax?
What will you see on a CXR?
- Pleura is abnormal if pleural space becomes visible
- The pneumothorax is clearly black with a clear margin. This area is NOT vascularised
- Notice the rim of air above the diaphragm. If it is more than 2cm and patient is short of breath then they need hospital care.
What do you need to look out for on CT scans (and CXRs)?
identify atypical collections of gas, changes in lung markings, presence of mediastinal shift and/ or tracheal deviation’ lucent/ dark lung field, deep sulcus sign
What is the management of primary pneumothorax?
- If rim of air is less than 2cm and the patient is not short of breath, then discharge
- Otherwise attempt aspiration
- If this fails or if rim of air >2cm, insert chest drain
- Patients should be told to quit smoking to reduce risks of other episodes
What is the management of secondary pneumothorax?
- If patients are over 50 and rim of air >2cm and patient is short of breath, then chest drain
- If not and rim of air is between 1-2cm, aspiration should be done. If aspiration fails (pneumothorax >1cm) insert chest drain.
- Patients should be admitted for at least 24 hours.
- If pneumothorax <1cm, then give oxygen.
