Pulm. Pneumotorax (10-28) (2) Flashcards
UW. Spontaneous. there are primary and secondary. primary assoc with what?
No preceding event or lung disease; thin, young male
UW. Spontaneous. there are primary and secondary. secondary assoc with what?
Underlying lung disease, eg COPD
UW. Tension. assoc with what?
LIFE THREATENING
Often due to trauma or mechanical ventilation
UW. Spontaneous. signs and symptoms?
Chest pain, dyspnea
Decr. breath sounds, decr. chest movement
Ipsilateral hyperresonance to percusion
UW. Spontaneous. what percusion?
Ipsilateral hyperresonance to percusion
UW. Tension. signs and symptoms?
same as in spontaneous +
a) HEMODINAMIC INSTABILITY
b) tracheal deviation away from affected side
UW. Spontaneous. Imaging? 2
Abscent lung markings
Visceral pleural line
UW. Tension. Imaging? 2+2
same as in spontaneous+
a) contralateral MEDIASTINAL SHIFT
b) Ipsilateral hemidiaphragm flattening
UW. Spontaneous. Management? small
small =< 2 cm.
Observation and oxygen
UW. Spontaneous. Management? large and stable
Needle aspiration or chest tube
UW. tension. Management?
URGENT needle decompresion or chest tube placement
UW. what sign may be supportive for pneumothorax?
Increased brightness on transillumination of the chest is supportive of the diagnosis.
UW. tension. causes?
CVK!!!!
UW. tension. what worsens?
positive pressure ventilation
UW. tension. why impaired cardio function?
Air within the pleural space that displaces mediastinal structures and compromises
cardiopulmonary function.
UW. tension. clinical?
SOB
tachycardia
tachypnea
hypotension
neck vein distension
UW. tension. If HD stabe or unsure –> imaging
.
UW. tension. treatment. if unstable HD?
Needle thoracostomy in hemodynamically unstable.
UW. tension. treatment. Needle thoracostomy place?
2nd left intercostal space along midclavicular line
UW. tension. treatment. needle followed by emergency tube thoracostomy. what place?
Fifth intercostal space in the midaxillary line.
UW. tension. treatment. needle –> tube – next point buvo sitas:
This is an important exception to the typical order or ABC but is necessary
because PPV rapidly increases accumulated air and intrathoracic pressure –> exacerbating TP and cardiovascular collapse.
.
UW. Spontaneous. other risk apart young/tall men?
smoking, Marfan, thoracic endometriosis
Also: secondary to lung disease (COPD, CF)
UW. Spontaneous. clinical?
SOB, hypoxia, unilateral breath sounds, chest pain, hyperresonance on percussion
UW. Spontaneous. Management depends on size of the lesion and clinical status
.
UW. Spontaneous. small treatment?
Clinically stable patients with small pneumothoraces: supplemental
oxygen; it resolves spontaneously.
UW. Spontaneous. large and stable treatment?
Large pneumothoraces in stable patient: get decompressed with a
large bore needle inserted in the 2nd or 3rd IC space midclavicular or
4th or 5th IC space midaxillary.
UW. Spontaneous. large and HD NONstable treatment?
Hemodynamically unstable should get emergency tube thoracotomy.
● If not available –> urgent needle decompression.
UW. Spontaneous. treatment.
If lungs fail to adequately re-expands (e.g., <90% expansion) and a
persistent air leak is present, placement of a one-way valve, creation of a blood patch, or VATS can be used.
.
UW. Spontaneous. treatment. if recurrent –>
Recurrent VATS pleurodesis or chemical (e.g., tetracycline derivative, talc) pleurodesis can be performed.
