Pneumothorax and Haemothorax Flashcards
What is lobar collapse?
Obstruction of airway prevents airflow to lobe and causes collapse
What can cause lobar collapse?
Lung cancer
Asthma
Infection
Foreign body
What is the presentation of lobar collapse?
Acute= SOB
Chronic= asymptomatic, SOB
Features of cause
What investigation if done for lobar collapse?
CXR
- tracheal deviation towards affected side
- elevation of hemidiaphragm
What are the types f pneumothorax?
Non tension
Tension- acts as one way valve, allowing air to enter but not exit the pleural space, increasing pressure
What are the causes of pneumothorax?
Spontaneous- primary or secondary
Traumatic- iatrogenic or non iatrogenic
What is a primary spontaneous pneumothorax?
No underlying lung pathology
Normally tall, thin 20-30yo men
What is a secondary spontaneous pneumothorax?
Underlying lung pathology
What are the risk factors for pneumothorax?
Existing lung disease
Connective tissue disease- Marfan, RA
Ventilation, including NIV
What is the presentation of pneumothorax?
Small and otherwise well= asymptomatic Sudden onset dyspnoea, tachypnoea, pleuritic chest pain, tachycardia Reduced chest expansion Hyperresonance Absent/reduced breath sounds
What is the deviation of the trachea in tension and non tension pneumothoraces?
Tension= away from affected side
Non tension= towards
What investigation is done for pneumothorax?
CXR
What is the management of a tension pneumothorax?
Needle decompression with large bore cannula 2nd intercostal space mid clavicular line
Chest tube 5th intercostal space midaxillary line
What is the management of a primary pneumothorax?
<2cm, asymptomatic= observe
>2cm, symptomatic= aspiration, chest drain if failure of aspiration
What is the management of a secondary pneumothorax?
<1cm= observe
1-2cm= aspiration
>2cm, symptomatic, >50yo, failure of aspiration= chest drain
What are the management options of pneumothorax?
Observe Aspiration Chest drain Talc poudrage Pleurodesis Pleurectomy
What are the principles of inserted a chest drain?
Triangle of safety= 5th intercostal space, midaxillary line, anterior axillary line
Inserted just above rib to avoid neuromuscular bundle
What causes a haemothorax?
Usually laceration of lung, intercostal vessels or internal mammary artery
What is the presentation of a haemothorax?
Chest pain Dyspnoea Reduced/absent breath sounds Hyporesonant, stony dull Tachycardia Massive= decompensation
What is the investigation for haemothorax?
CXR
What is the management of a haemothorax?
Large bore chest drain- if >1500mls drained, contact thoracic surgery
