Pneumothorax and Pleural Effusion Flashcards
What is pneumothorax
Collapsed lung due to air leaking into the pleural space, separating the lung from the chest wall
What are the signs and symptoms of pneumothorax
Dyspnoea
Pleuritic chest pain
Cough
(Sudden onset)
Tachycarida and hypotension
Decreased unilateral lung expansion
Resonant percussion note
Quiet or absent breath sounds
Describe primary and secondary pneumothorax
Primary - most common in young, tall and thin men. Most cases caused by small sub-pleural bulla bursting and allowing air into pleural cavity
Secondary - can be due to underlying lung disease, secondary to trauma or secondary to high pressure ventilation
Name some causes of secondary pneumothorax
COPD
Asthma
Bronchiectasis
Lung cancer
Pulmonary infections
Rib # that penetrates viseceral pleura
Severe blunt chest trauma may puncture both pleural layers
Mild sharp chest trauma may puncture both pleural layers
What is a tension pneumothorax and what is the treatment
Tension pneumothorax - ocurs where air enters pleural cavity but cannot escape because of a flap that closes on expiration
Treatment is insertion of plastic cannula (venflon) into second intercostal space in mid-clavicular line to drain the air in the pleural space
What are the signs and symptoms of a tension pneumothorax
Severe distress
Dyspnoea
Pleuritic chest pain
Fatigue
Tachycardia and hypotension
Raised JVP
Deviated trachea
Displaced apex beat
Increased percussion note
Silent breath sounds
What is a pleural effusion
Pleural effusion is where there is increased pleural fluid within the pleural cavity caused by dysfunction in either production or absorption of pleural fluid
What are the causes of pleural effusion
Failure of absorption - hypoproteinaemia (liver failure/cirrhosis, nephrotic syndrome), congestive HF, lymphatic obstruction
Over production - occurs due to increased capillary permeability, commonly caused by inflammation. E.g. infection, cancer, pulmonary infarction due to PE
What are the signs and symptoms of pleural effusion
Dyspnoea
Chest pain
Cough
(Gradual onset)
Trachea deviation
Decreased unilateral lung expansion
Stony dull percussion note
Quiet breath sounds
Decreased vocal resonance
What typically causes bilateral effusion and what typically causes unilateral effusion
Bilateral - failure of abrosption, e.g. HF or nephrotic syndrome
Unilateral - PE, pneumonia, lung cancer
What is pursed lip breathing and why is it seen
Pursed lip breathing is where paitent breathes out slowly through mouth with pursed lips
This increases resistance to outflow on expiration and maintains intrathoracic airway pressure allowing for small airways to remain open for longer
This prolongs period for gas exchange to occur and allows more air to empty
List conditions that cause breahtlessness according to the time scale in which they cause breathlessness
Instant to minutes - PE, acute asthma, pneumothorax, foreign body
Hours to days - infection, pneumonia, acute exacerbation of COPD, pleural effusion
Weeks to months - pleural effusion, HF, lung cancer, anaemia
Months to years - COPD, pulmonary fibrosis
