Pneumothorax -Goya Flashcards
What is a pneumothorax? What are the 3 types?
when there is an opening on the surface of the lung or airways that allows air to enter the pleural space between the pleura, creating an actual space
Primary spontaneous pneumothorax (PSP), Secondary Spontaneous Pneumothorax (SSP) and tension pneumothorax
What causes PSPs?
rupture of sub pleural emphysematous blebs located at the apices
(blebs associated with congenital abnormalities and inflammation of the airways)
strong association between PSP and smoking
pts tend to be tall and thin
What are the CXR findings associated with Pneumothorax?
Presence of visceral-pleural line (vertical line)
Deep sulcus sign
Hydropneumothorax (seen in CT–> collapse of lung with air fluid below)
Tension Pneumothorax
What are the clinical manifestations and PE findings associated with PSP?
normally develops at rest
peak age is early 20s (rare > 40)
chest pain (to side of pneumo) and dyspnea
decreased chest wall excursion, diminished breath sounds and hyper resonant percussion on the affected side
A 29-year-old student is brought to the ED after he is stabbed immediately inferior to the right scapula about the level of T7 with a sharp unknown object. Patient states that during a group discussion a conflict broke out, and the student was stabbed while walking out of the room. His blood pressure is 110/64 mm Hg, heart rate is 116/min, respiratory rate is 20 breaths/min, and oxygen saturation is 92% on 100% oxygen mask. On physical exam the wound is small but seems to bubble with each inspiration and expiration. For your first step you decide to get a CXR, which of the following would be most likely to find on imaging? (A) Right upper lobe consolidation (B) Right pneumothorax (C) Right solitary pulmonary nodule (D) Right pulmonary embolism
(B) Right pneumothorax
What might the ABG for a pneumothorax show?
hypoxemia
hypercapnea
acute reap alkalosis maybe present if pain, anxiety and hypoxemia are bad
What is the recurrence rate of a PSP?
52%
When is observation recommended for a pneumothorax?
young pt who is asyptomatic and has normal vitals
pneumothorax <15%
A 29-year-old student came to the clinic for annual physical exam. His blood pressure is 110/64 mm Hg, HR-90/min, RR 20 breaths/min, and o2 sat 98% on room air. On physical exam he had decreased breath sound on right apex. His chest x-ray shows 5% right apical pneumothorax, which of the following is next best step?
A. Observation
B. Simple Aspiration
C. Tube Thoracostomy
D. Tube Thoracostomy with sclerosing agent
E. Thoracoscopy
A. Observation
Who should be treated with simple aspiration?
initial treatment for most PSP > 15% (if stable)
A 29-year-old student came to the clinic for shortness of breath. His blood pressure is 110/64 mm Hg, HR-90/min, RR 20 breaths/min, and o2 sat 98% on room air. On physical exam he had decreased breath sound on right apex. His chest x-ray shows 25% right apical pneumothorax, which of the following is next best step?
A. Observation
B. Simple Aspiration
C. Tube Thoracostomy
D. Tube Thoracostomy with sclerosing agent
E. Thoracoscopy
B. Simple Aspiration
When should pts be treated with a tube thoracostomy? Does this procedure reduce the risk of reoccurrence?
Failure of simple aspiration or patients that have a recurrent spontaneous pneumothorax
Does not reduce the incidence of recurrence
What is the effective treatment for SPS that helps prevent reoccurrence? When is this procedure indicated?
Thoracoscopy (VATS)
indications:
- aspiration fails
- lung remains expanded after 3 days of tube thoracostomy
- bronchopleural fistula persist after 3 days
- recurrent pneumo after chemical pleurodesis
- in an occupation where recurrence is dangerous (airline pilot)
What is SSP normally seen in?
COPD
Symptoms are more severe than PSP*
–> Less pulmonary reserve, so any decrease in pulmonary function is more noticeable
ABG more abnormal in SSP than PSP
How is diagnosis of SSP established?
demonstrating the visceral pleural line (hard to see in hyper inflated COPD)
