Pneumothorax

Question 1

what is a pneumothroax

Question 2

outward recoil of the rib cage and inward coil balance out and cause a __ pressure

Question 3

Signs and symptoms

Answer 3

Question 4

dx of pneumothorax

Answer 4

 High degree of clinical suspicion
 Chest X-ray
 Ultrasound can be useful to rule out PTX in trained
hands  CT can pick up some x-ray occult PTX

Question 5

which lung has pneumothorax

Answer 5

the right one

• Area of hyperlucency (absence of lung markings)
• Reflection of visceral pleura
• May have small effusion

Question 6

primary vs secondary pneumothorax

Answer 6

pirmary: Occurring without preceding trauma or other cause and without underlying lung disease

Secondary pneumothorax:

-Pneumothorax that occurs in someone with underlying lung disease: eg. COPD, IPF

Higher morbidity and mortality than PSP

Question 7

Answer 7

Rupture of apical sub-pleural bleb or
bullae

primary spontaneous PTX

Question 8

risk factors for primary spontaneous pneumothorax

Answer 8

• tall
• slim
• male
• younger age
• smoker

Question 9

what is tension ptx

Answer 9

when pleural pressure exceeds atmospheric pressure leading to decreased venous return and decreased cardiac output

Question 10

how does tension pneumothorax contribute to obstructive shock

Answer 10

because it decreases venous return –> decreases Cardiac output –> decreases BP CAUSES OBSTRUCTIVE SHOCK

Question 11

you will tracheal deviation to the ____ side in a tension pneumothorax

Answer 11

contralateral.

Question 12

management of tension pneumo

Answer 12

this is a medical emergency

Medical emergency!!!
• Decompression!!!
• Large bore needle 2nd intercostal space, mid clavicular line
• Chest tube + water seal

Question 13

when should you treat a ptx?

Answer 13

• if it’s tension
• if it’s symptomatic
• secondary pneumothorax
• patient is ventialted
• complex pleural disease
• breathlessness indicates the need for a more active intervention

Question 14

does every ptx need a chest tube?

Answer 14

no.◼ PSP patients who are not breathless and have a
small pneumothorax (<2 cm between lung and
chest wall) can be discharged with early
outpatient follow up

Question 15

IN TERMS OF CHEST TUBE INSERTION SITE

Anterior – mid-clavicular, ____ intercostal space

 Lateral – Mid-axillary,____intercostal space

Answer 15

Anterior – mid-clavicular, 2nd intercostal space

 Lateral – Mid-axillary, 4-6th intercostal space

Question 16

how do you know a chest tube is working (it should have a water seal so that air cannot leak back into lungs)

Answer 16

When inserted you should see

 Bubbles in the water seal container
(air being drained from the pleural space)

 Fluctuations in the water seal container
(representing fluctuations in pleural pressure with respiration)

Question 17

to prevent recurrence of ptx, it’s important to mitigate risk factors like quitting smoking. What types of pleurodesis options are there

Answer 17

1. sclerosing agent (talc)
2. VATS pleural abrasion: abrasion of the pleural space so that the visceral pleura and the parietal layer cannot separate and have air accumulate between it

Question 18

Question 19

 Hemodynamically
unstable, 35 yo
male with sudden
onset dyspnea and
chest pain 3 hours
ago.

what’s going on?

Answer 19

this is a major pneumothorax ont he left hand side. there is a completely black lung and hilum cannot be seen on left side. there is also a tracheal shift to the contralateral side. this is a tension pneumo