Random revision Flashcards
Primary vs secondary pneumothorax
Primary - tall people
Secondary - in someone with lung conditions
Iatrogenic pneumothorax causes
NIV, CVC insertion
What is another cause of pneumothorax
Trauma
How do you manage pneumothorax
If primary and under 2cm - discharge
If over 2cm - chest drain
If secondary and 1-2cm - needle aspiration with 14G needle
if over 2cm - chest drain
Discharge and follow up advice in pneumothorax
F/U in 2 to 4 weeks
Discharge - no air travel until 1 week after and x ray is clear
No scuba diving unless bilateral surgical pleurectomy and normal CT
Complications of chest drain
Immediately- failure, pain, pneumothorax, haemothorax
Later - infection, haematoma, long thoracic nerve palsy
Later than that - scar
What is a flail chest
3 rib fractures which cause asymmetrical breathing - as seen on chest x ray
Manage with analgesia, chest physio and surgical fixation
Pleural effusion - management
21 G needle + 50ml syringe for aspiration
If the contents are cloudy or if the pH of the contents are less than 7.2 with suspected infection, insert a chest drain.
Treat underlying cause
What do you do with the pleural effusion aspirate
Check:
Protein level - raised above 30g/L in exudative causes
LDH (marker of cell damage) - raised in exudative causes
pH
Send for MC&S
Glucose - if low - RA or TB
Blood - TB, PE or mesothelioma
Amylase - raised in pancreatitis or oesophageal perforation
What criteria do you use to tell you if this is transudative or exudative if the protein isn’t above 30g/L exactly?
Light’s criteria:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
How do you treat recurrent pleural effusion?
Pleurodesis
Repeat aspirations
SOB drugs
Indwelling pleural catheter
What is pleurodesis
Where a drug is put into the lung pleura space to obliterate it so that nothing collects there
How would you differentiate between cancer vs infective cause of pleural effusion?
Lymphocytes - malignancy (chronic)
Neutrophils mainly - infection (acute)
How do you differentiate between tension pneumothorax and simple pneumothorax?
Tension pneumothorax - hypotension and SOB, tracheal deviation
Simple pneumothorax - pleuritic chest pain
How do you deal with a tension pneumothorax?
14G needle immediately, second intercostal space - skip the cxr
