Pneumothorax Flashcards
Occurs without antecedent trauma to the thorax
Spontaneous Pneumothorax
occurs in the absence of underlying disease
usually d.t rupture of apical pleural blebs - small cystic spaces that lie within or immediately under the visceral pleura
Primary Spontaneous Pneumothorax
occur almost exclusively in smokers
suggests that these patients have subclinical
lung disease
Management of Primary Spontaneous Pneumothorax
simple aspiration
thoracoscopy with stapling of blebs and pleural abrasion
thoracoscopy or thoracotomy with pleural abrasion
Occurs in the presence of an underlying disease
due to COPD, but pneumothoraxes have been reported with virtually every lung disease
Secondary Pneumothorax
Management of Secondary Pneumothorax
tube thoracostomy
thoracoscopy or thoracotomy with the stapling of blebs and pleural abrasion
pleurodesis - intrapleural injection of a sclerosing agent - doxycycline
Results from penetrating or nonpenetrating chest injuries
Traumatic Pneumothorax
Management of Traumatic Pneumothorax
tube thoracostomy
Type of traumatic pneumothorax that is becoming more common
Iatrogenic Pneumothorax
LEADING CAUSES of Iatrogenic Pneumothorax
transthoracic needle aspiration
thoracentesis
insertion of central intravenous catheters
Pressure in the pleural space is positive throughout the respiratory cycle
usually occurs during mechanical ventilation or resuscitative efforts
positive pleural pressure - life-threatening
• ventilation is severely compromised
• the positive pressure is transmitted to the mediastinum –> ↓ venous return to the heart and ↓ cardiac output
Tension Pneumothorax
PHYSICAL EXAMINATION in Tension Pneumothorax
enlarged hemithorax with no breath sounds
hyperresonance to percussion
shift of the mediastinum to the contralateral side
Management of Tension Pneumothorax
large-bore needle - should be inserted into the pleural space through the 2nd anterior
intercostal space
needle should be left in place until a thoracostomy tube can be inserted
