Pneumothorax + Pleural Effusion Flashcards
What is a pneumothorax?
When air enters into the pleural space (visceral and parietal pleural) separating the lung from the chest wall which can then lead to lung collapse
What are the 2 categories of pneumothorax?
Simple
Tension
What are the causes of pneumothorax?
Primary spontaneous pneumothorax
Secondary pneumothorax
Traumatic pneomthorax
Iatrogenic pneumothorax
What are some causes of secondary pneumothorax?
COPD
Asthma
TB
Interstitial Lung Disease
Pneumonia
Cystic fibrosis
Marfans
Erlos Danlos syndrome
What are some iatrogenic causes of pneumothorax?
Lung biopsy
Mechanical ventilation
Central line
Subclavian line insertion
What are the risk factors for developing a spontaneous pneumothorax?
Tall thin
Male
Smoker
Smokes cannabis
What are the symptoms of a pneumothorax?
Sudden chest pain
SOB/resp distress
Palpitations
What are the signs of a pneumothorax on examination?
Tachypnoea
Decreased or absent breath sounds
Hyper resonance
Reduced. Chest wall movements
Hypoxia
Central cyanosis
Hypotension
Distended neck veins
Tracheal deviation
CARDIAC ARREST
What investigation/imaging should be done if you suspect a pneumothorax?
Erect CXR
How does a pneumothorax appear on an erect CXR?
No lung markings and lines demarcating the edge of the lung
How do you manage a patient with a pneumothorax?
Depends on their risk
How do you manage a high risk patient witht a pneumothorax?
Chest drain
What is considered a high risk pneumothorax?
Haemodynaimc compromise
Bilateral pneumothorax
Hypoxia
Underlying lung disease
How is a lower risk pneumothorax managed?
Regular outpatient reviews
Pleural Vent Ambulatory Device
Short term drainage or needle aspiration
Where is a chest drain inserted to treat a pneumothorax?
Triangle of safety
What are the borders of the triangle of saftey where you insert a chest drain to relieve a pneumothorax?
Midaxillary line (lat edge of lat dorsi)
Anterior axillary line (lat edge of pec major)
5th intercostal space
Where in relation to the 5th rib is the chest drain inserted and why?
Above the rib
The neurovascular bundle for the rib sits on the underside the rib
What is the procedure of putting in a chest drain?
Insert the drain under the rib
Put hte external part of the drain underwater creating a seal
What are some issues that can happen with a chest drain?
Blocked or kinked tube
Incorrect position in chest
Not correctly connected to the water portion
What are some comlications of a chest drain?
Air leaks
Surgical emphysema (subcutaneous emphysema)
What is a tension pneumothorax?
A one way valve which lets air into the pleural space but not out
What are the signs of a tension pneumothorax?
Tracheal deviation away from the side of the pneumothorax
Reduced air entry to affecttted side
Increased resonance to percussion on affected side
Tachycardia
Hypotension
What is the pathophysiology of a cardio respiratory arrest following a tension pneumothorax?
Increasing air in the pleural space pushes the mediastinum across to the opposite side kinking thee big vessels in the mediastinum
What side does the trachea deviate to in a tension pneumothorax?
To the opposite side
What is the management of a tension pneumothorax?
IMMEDIATELY Insert a large bore cannula into the second intercostal space in the mid clavicular line
What is a pleural effusion?
Collection of fluid in the pleural space
What are the 2 categories of pleural effusion?
Exudative
Transudate r
What protein content is considered an exudative pleural effusion?
What protein content is considered a transudative pleural effusion?
Exudative pleural effusion - protein > 30g/L
Transudative pleural effusion - protein < 30g/L
What is the name of the criteria to classify an Exudative or transudative pleural effusion?
Lights criteria
What is lights criteria for classifying pleural effusion as exudate if 1 or more is true?
Pleural fluid protein/serum protien > 0.5
Pleural fluid LDH/sereum LDH greater than 0.6
Pleural fluid LDH greater than 2-3 the normal upper limit of serum LDH
What are some exudative causes pleural effusion?
Infection (pneumonia, TB)
Cancer (lung cancer, mesothelioma)
Rheumatoid arthritis
Sjögren’s syndrome
Amiodarone.
What are some transudative causes of pleural effusion?
Congestive Heart failure
Mitral stenosis
SVC obstruction
Hypoalbuminaemia
Hypothyroidism
Meigs syndrome
PE
Liver cirrhosis
What is Meigs syndrome?
Triad of:
-benign ovarian tumour (fibroma)
-pleural effusion
-Ascites
How is Meigs syndrome managed?
Removal of the fibroma will fix the ascites and the pleural effusion.
How does a pleural effusion present on examination?
SOB
Dullness to percussion on the effusion
Reduced breath sounds
Tracheal deviation away from effusion
What investigation/imaging is good for identifying pleural effusion?
CXR
USS and CT
How does a pleural effusion look on a chest x-ray? (CXR)
Blunting of the costophrenic angles
Fluid in the lung fissures
Larger effusions have a meniscus
Tracheal deviation and mediastinal deviation
What is the management of a pleural effusion?
Conservatively (treat underlying cause)
Effusion drainage or aspiration
Aspirate the fluid for analysis to see type of pleural effusion
What is an empyema?
Infected pleural effusion
When do you suspect an empyema?
Improving pneumonia but a new or ongoing fever
What is shown in a pleural aspirate of an empyema?
Pus
Low pH
Low glucose
High LDH
How is an empyema treated?
Chest train
Antibiotics
What is a chylothorax?
When chyle (fat and lymphocytes) enters into the pleural space
What can cause a chylothorax?
Traumatic injury to the thoracic duct (neck surgery or trauma to chest)
Malignancy
Lymphoma
TB
