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Respiratory System > Pneumothorax + pleural disease > Flashcards

Pneumothorax + pleural disease Flashcards

1
Q

Define simple pneumothorax

A

Presence of air within the pleural space
Air moves in and out

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2
Q

Define tension pneumothorax

A
  • Presence of air within the pleural space
  • Air moves in but NOT out
  • Increases pressure in pleural space > pushes onto mediastinum
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3
Q

Types of pneumothorax

A

Simple
Tension
.
Iatrogenic/trauma
Spontaneous - primary or secondary

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4
Q

What are the types of spontaneous pneumothorax?

A
  • primary: no underlying lung disease
  • secondary: with existing lung disease
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5
Q

How is inspiration affected in a patient with a pneumothorax?

A
  • air moves into pleura due to lower pressure
  • air in pleura limits expansion of lungs
  • causes higher pressure in lungs
  • so there is a smaller pressure gradient in lungs compared to outside air
  • less air moves into lungs
  • inspiration is impaired
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6
Q

Symptoms of pneumothorax

A

Pleuritic chest pain
Dyspnoea

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7
Q

What is a spontaneous pneumothorax?

A

Occurs without obvious trauma/iatrogenic

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8
Q

Signs of pneumothorax

A

Reduced air entry
Hyper resonant
Reduced chest expansion

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9
Q

Diagnosis of pneumothorax

A

erect chest X ray
CT thorax to detect penumothorax that is too small to be seen on CXR

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10
Q

What are the radiological findings of a simple pneumothorax?

A

Lung doesn’t fill the whole chest

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11
Q

What would suggest a pneumothorax on percussion of the chest?

A

Hyper resonant

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12
Q

Management of a pneumothorax

A

Let the air out:
- needle aspiration
- intercostal chest drain
- pleural vent ambulatory device (outpatient)
.
- smoking cessation
- no flying until 2 week after resolution on CXR
- no scuba diving until reviewed by thoracic surgeons

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13
Q

BTS guidelines for spontaneous pneumothorax management (depending on risk)

A
  • if high risk characteristics e.g hemodynamic instability, hypoxia, underlying lung disease: chest drain
  • if symptomatic + of sufficient size: needle aspiration or pleural vent ambulatory device
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14
Q

Outline a pleural vent ambulatory device

A
  • involves a catheter being inserted into the pleural space attached to a device stuck to the upper chest
  • the device allows air to exit but not enter
  • patients can wear as outpatients until pneumothorax is resolved
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15
Q

Describe the placement of an intercostal tube in the treatment of pneumothorax

A
  • In the triangle of safety: under armpits at side of chest
  • Above the rib to avoid damage to intercostal neurovascular bundle
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16
Q

Borders of the triangle of safety

A
  • anteior: posterior border of pectoralis major
  • posterior: anterior border of latissimus dorsi
  • inferior: 5th intercostal space (in line with nipples)
  • in mid axillary line
17
Q

How do we prevent air entering the drain during treatment of a pneumothorax?

A

Underwater seal
Hickman valve

18
Q

Complications of chest drains

A
  • air leaks around drain site
  • surgical emphysema: when air collects in SC tissue
19
Q

Why is a water seal used during chest drains?

A

To prevent air entering the drain

20
Q

Describe the clinical features suggestive of a tension pneumothorax

A
  • Pleuritic chest pain
  • Dyspnoea
  • Tachycardia
  • Low BP
  • Cyanosis
  • Deviated trachea
  • Reduced air entry on affected side
21
Q

Describe the radiological features suggestive of a tension pneumothorax

A
  • Mediastinal shift
  • Lung doesn’t fill to edges of ribcage
  • tracheal deviation
22
Q

Treatment of tension pneumothorax

A

Emergency chest drain
insert a large bore cannula into the 2nd ICS in midclavicular line

23
Q

How does a pneumothorax cause a collapsed lung?

A
  • Intrapleural pressure equalises with atmospheric pressure
  • This changes the pressure differential between intrapulmonary + intrapleural pressure
  • lung collapses due to change in trans pulmonary pressure
24
Q

Define pleural effusion

A

Excess fluid in the pleura

25
Q

Define haemothorax

A

Blood within the pleural space

26
Q

Define chylothorax

A

Accumulation of lymph in the pleural cavity

27
Q

Define parapneumonic effusion

A

Effusion next to pneumonia in the lung

28
Q

Define empyema

A

Collection of pus within the pleural cavity

29
Q

When should you suspect empyema?

A

in a patient with improving pneumonia but a new or ongoing fever

30
Q

What is seen in pleural aspiration of empyema?

A
  • pus
  • low pH
  • low glucose
  • high LDH
31
Q

Treatment of empyema

A

chest drain + antibiotics

Respiratory System (25 decks)

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