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 above the rib
Put hte external part of the drain underwater creating a sealb
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
