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Y3(M) - Respiratory > Pneumothorax + Pleural Effusion > Flashcards

Pneumothorax + Pleural Effusion Flashcards

1
Q

What is a pneumothorax?

A

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

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2
Q

What are the 2 categories of pneumothorax?

A

Simple
Tension

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3
Q

What are the causes of pneumothorax?

A

Primary spontaneous pneumothorax
Secondary pneumothorax
Traumatic pneomthorax
Iatrogenic pneumothorax

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4
Q

What are some causes of secondary pneumothorax?

A

COPD
Asthma
TB
Interstitial Lung Disease
Pneumonia
Cystic fibrosis
Marfans
Erlos Danlos syndrome

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5
Q

What are some iatrogenic causes of pneumothorax?

A

Lung biopsy
Mechanical ventilation
Central line
Subclavian line insertion

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6
Q

What are the risk factors for developing a spontaneous pneumothorax?

A

Tall thin
Male
Smoker
Smokes cannabis

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7
Q

What are the symptoms of a pneumothorax?

A

Sudden chest pain
SOB/resp distress
Palpitations

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8
Q

What are the signs of a pneumothorax on examination?

A

Tachypnoea
Decreased or absent breath sounds
Hyper resonance
Reduced. Chest wall movements
Hypoxia
Central cyanosis
Hypotension
Distended neck veins
Tracheal deviation
CARDIAC ARREST

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9
Q

What investigation/imaging should be done if you suspect a pneumothorax?

A

Erect CXR

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10
Q

How does a pneumothorax appear on an erect CXR?

A

No lung markings and lines demarcating the edge of the lung

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11
Q

How do you manage a patient with a pneumothorax?

A

Depends on their risk

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12
Q

How do you manage a high risk patient witht a pneumothorax?

A

Chest drain

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13
Q

What is considered a high risk pneumothorax?

A

Haemodynaimc compromise
Bilateral pneumothorax
Hypoxia
Underlying lung disease

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14
Q

How is a lower risk pneumothorax managed?

A

Regular outpatient reviews
Pleural Vent Ambulatory Device
Short term drainage or needle aspiration

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15
Q

Where is a chest drain inserted to treat a pneumothorax?

A

Triangle of safety

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16
Q

What are the borders of the triangle of saftey where you insert a chest drain to relieve a pneumothorax?

A

Midaxillary line (lat edge of lat dorsi)
Anterior axillary line (lat edge of pec major)
5th intercostal space

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17
Q

Where in relation to the 5th rib is the chest drain inserted and why?

A

Above the rib

The neurovascular bundle for the rib sits on the underside the rib

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18
Q

What is the procedure of putting in a chest drain?

A

Insert the drain under the rib
Put hte external part of the drain underwater creating a seal

19
Q

What are some issues that can happen with a chest drain?

A

Blocked or kinked tube
Incorrect position in chest
Not correctly connected to the water portion

20
Q

What are some comlications of a chest drain?

A

Air leaks
Surgical emphysema (subcutaneous emphysema)

21
Q

What is a tension pneumothorax?

A

A one way valve which lets air into the pleural space but not out

22
Q

What are the signs of a tension pneumothorax?

A

Tracheal deviation away from the side of the pneumothorax
Reduced air entry to affecttted side
Increased resonance to percussion on affected side
Tachycardia
Hypotension

23
Q

What is the pathophysiology of a cardio respiratory arrest following a tension pneumothorax?

A

Increasing air in the pleural space pushes the mediastinum across to the opposite side kinking thee big vessels in the mediastinum

24
Q

What side does the trachea deviate to in a tension pneumothorax?

A

To the opposite side

25
Q

What is the management of a tension pneumothorax?

A

IMMEDIATELY Insert a large bore cannula into the second intercostal space in the mid clavicular line

26
Q

What is a pleural effusion?

A

Collection of fluid in the pleural space

27
Q

What are the 2 categories of pleural effusion?

A

Exudative
Transudate r

28
Q

What protein content is considered an exudative pleural effusion?

What protein content is considered a transudative pleural effusion?

A

Exudative pleural effusion - protein > 30g/L

Transudative pleural effusion - protein < 30g/L

29
Q

What is the name of the criteria to classify an Exudative or transudative pleural effusion?

A

Lights criteria

30
Q

What is lights criteria for classifying pleural effusion as exudate if 1 or more is true?

A

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

31
Q

What are some exudative causes pleural effusion?

A

Infection (pneumonia, TB)
Cancer (lung cancer, mesothelioma)
Rheumatoid arthritis
Sjögren’s syndrome
Amiodarone.

32
Q

What are some transudative causes of pleural effusion?

A

Congestive Heart failure
Mitral stenosis
SVC obstruction
Hypoalbuminaemia
Hypothyroidism
Meigs syndrome
PE
Liver cirrhosis

33
Q

What is Meigs syndrome?

A

Triad of:
-benign ovarian tumour (fibroma)
-pleural effusion
-Ascites

34
Q

How is Meigs syndrome managed?

A

Removal of the fibroma will fix the ascites and the pleural effusion.

35
Q

How does a pleural effusion present on examination?

A

SOB
Dullness to percussion on the effusion
Reduced breath sounds
Tracheal deviation away from effusion

36
Q

What investigation/imaging is good for identifying pleural effusion?

A

CXR
USS and CT

37
Q

How does a pleural effusion look on a chest x-ray? (CXR)

A

Blunting of the costophrenic angles
Fluid in the lung fissures
Larger effusions have a meniscus
Tracheal deviation and mediastinal deviation

38
Q

What is the management of a pleural effusion?

A

Conservatively (treat underlying cause)

Effusion drainage or aspiration

Aspirate the fluid for analysis to see type of pleural effusion

39
Q

What is an empyema?

A

Infected pleural effusion

40
Q

When do you suspect an empyema?

A

Improving pneumonia but a new or ongoing fever

41
Q

What is shown in a pleural aspirate of an empyema?

A

Pus
Low pH
Low glucose
High LDH

42
Q

How is an empyema treated?

A

Chest train
Antibiotics

43
Q

What is a chylothorax?

A

When chyle (fat and lymphocytes) enters into the pleural space

44
Q

What can cause a chylothorax?

A

Traumatic injury to the thoracic duct (neck surgery or trauma to chest)

Malignancy
Lymphoma
TB

Y3(M) - Respiratory (6 decks)

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