Respiratory - Pneumothorax Flashcards
What is a pneumothorax?
Air enters pleural space separating lung from the chest wall
What is the typical patient with a PTX?
Tall
Thin
Young
Sudden breathlessness with pleuritic chest pain during sports
What can cause a PTX?
Spontaneous
Trauma
Iatrogenic
Lung pathologies
What is used to diagnose a PTX?
CXR
CT thorax if PTX is too small
What is the management of a PTX?
No SOB and less than 2cm rim of air on CXR
- No treatment
- Follow-up in 2-4 weeks
SOB or more than 2cm rim of air on CXR
- Aspiration
- If aspiration fails twice, chest drain
Where is a chest drain inserted?
Safety Triangle
5th ICS
Lateral edge of Latissimus dorsi
Lateral edge of Pectoralis major
Where is the needle inserted when inserting a chest drain?
Above the rib
Neurovascular bundle below
CXR after insertion to check positioning
How are chest drains used?
External end underwater, creates a seal to prevent backflow of air
What is swinging?
Water in the drain will rise and fall due to changes in pressure in the chest
How do you know when a chest drain has been successful in treating a PTX?
Swinging of the water with respiration
CXR will show re-inflation of the lung
What are some potential problems with a drain if there is no re-inflation of the lung?
Blocked or kinked tube
Incorrect position in chest
Not correctly connected the bottle
What are the key complications of chest drains?
Air leaks around drain
Surgical emphysema, air collects in subcutaneous tissue
When do patients requires surgical intervention for a PTX?
Chest drain does not drain it
Persistent air leak in drain
PTX reoccurs
What are the surgical options for correcting a PTX?
Video-assisted thoracoscopic surgery
- Abrasive pleurodesis
- Chemical pleurodesis
- Pleurectomy
How does pleurodesis work?
Creates an inflammatory reaction in the pleural lining causing adhesion formation
Reforms pleural seal
What causes a tension PTX?
Trauma to chest wall that creates a one-way valve to let air in but not out
Air is drawn in during inspiration
Each breath increases pressure inside thorax causing mediastinal deviation
Causes cardiorespiratory arrest
