[Resp] Pneumothorax Flashcards
what is PTX split into?
primary vs. secondary
what is 1˚ PTX?
no underlying lung pathology
what is 2˚ PTX?
lung disease e.g. COPD / asthma
what does 1˚ PTX tend to be?
asymptomatic
can also present with:
- dyspnoea
- pleuritic chest pain
what does 2˚ PTX tend to have?
breathlessness out of proportion to the size of PTX
what should you do for PTX that is bilateral or pt is haemodynamically unstable?
proceed to chest drain
for 1˚ PTX, how would you manage a PTX that is >2cm / pt is complaining of breathlessness?
needle aspiration
for 1˚ PTX, what do you do if needle aspiration is successful (<2cm) and breathing is improved?
discharge + review in OPD
for 1˚ PTX, what do you do if needle aspiration is unsuccessful and breathing is not improved?
chest drain + admit
for 1˚ PTX, how would you manage a PTX that is <2cm / pt is not complaining of breathlessness?
discharge + review in OPD
for 2˚ PTX, how would you manage a PTX that is >2cm / pt is complaining of breathlessness?
chest drain + admit
for 2˚ PTX, how would you manage a PTX that is <2cm / pt is not complaining of breathlessness?
if PTX is 1-2cm → needle aspiration
if PTX is not 1-2cm → admit + observe for 24 h
for 2˚ PTX, what do you do if needle aspiration is successful (<1cm) and breathing is improved?
admit + observe for 24 h
for 2˚ PTX, what do you do if needle aspiration is unsuccessful and breathing is not improved?
chest drain + admit
what is a tension PTX?
medical emergency – requires emergency decompression with grey cannula into 2nd ICS, MCL
what happens in tension PTX?
one-way valve system
air in during inspiration, no air out during expiration
intrapleural pressure > atmospheric pressure → impaired venous return and reduced cardiac output
what is tension PTX associated with?
- ventilated pts on ICU / pts on NIV
- trauma
- acute asthma / COPD presentations
- blocked, clamped or displaced chest drains
what are the radiological features of tension PTX?
- airway pulled away from side of PTX
- mediastinal shift
- reduced lung markings
what are the features of haemodynamic instability associated with tension PTX?
- hypoxia
- hypotension
- tachycardia
increased lung compliance. dx?
emphysema
FEV1/FVC ratio < 0.7 dx?
obstructive lung pathology
T2RF with raised bicarbonate. dx?
chronic T2RF, aim sats 88-92%
what is the 1st line ix for PTX?
CXR
what is the mx of PTX dependent on?
type and size of PTX
what do all 2˚ PTX need?
admission
