S10 L1 Pneumothorax

Question 1

Pneumothoroax Pathophysiology

• Balance of which forces occurs in the pleura? How does this effect pressure?
• What is a pneumothorax?
• How can it lead to lung collapse?

Answer 1

Question 2

Different ways of classiyfing pneumothorax
- State 3 ways to do this

Answer 2

Simple vs Tension pneumothorax

Primary vs Secondary pneumothorax

Spontaneous vs Iatrogenic vs Traumatic pneumothorax

Question 3

Simple vs Tension (brief - will come back to in a future FC in more detail for both types)
- What are the main comparison points (similarities and differences) between each?

Answer 3

Question 4

Primary vs Secondary pneumothorax
- Compare the similarities and differences between these two types

Answer 4

Question 5

Causes

• Spontaneous
• Iatrogenic
• Trauma

Give examples of each of these.

Answer 5

Question 6

More detail: Subpleural bleb rupture
- How can this lead to a pneumothorax?

Answer 6

Subpleural bleb rupture:
the rupture of an underlying sub pleural bleb( pulmonary blebs are small thin-walled air-containing spaces) or bulla (bulla is a permanent, air-fi lled space within the lung parenchyma that is at least 1 cm in size) is thought to be responsible in many cases.
o The bleb or bulla ruptures creating an opening in the visceral pleura with consequent loss of the negative intrapleural pressure, and loss of the seal between the parietal and visceral pleura net result? Partial or complete lung collapse.

Question 7

Draw a flow chart to show the links between the following:
- Simple pneumothorax, tension pneumothorax, primary, secondary

Answer 7

Question 8

MORE DETAIL (some bits may be repeated)

Simple Pneumothorax:
- Why are patient haemodynamically stable?

• Signs and Symptoms

Answer 8

Air enters pleural space through pleural opening because of pressure differential BUT air can ALSO move out of the opening
= Air can move in and out of the pleura space

Question 9

Simple pneumothorax:
- CXR finding (on the A side of FC)

• CT-chest finding (on this Q side of FC) - answer before looking :-D

Answer 9

Question 10

Simple pneumothorax
- Treatment (3)

Answer 10

Treatment for a Simple pneumothorax:
Depends on size of pneumothorax and patients symptoms
• Conservative (small pneumothorax) - patient goes home, then later repeat chest x-ray and make sure their symptoms have resolved.
• Pleural aspiration - needle in pleural cavity and drain some of the air out (max amount if 2.5L)
• Chest drain insertion

Question 11

Chest drain insertion

• Do with the help of which imaging technique?
• Where to insert it?

Answer 11

Question 12

Chest drain:
- What happens to the other side of the chest drain?

Answer 12

Question 13

MORE DETAIL (some bits are repeated):
Tension pneumothorax 
- KEY point about tension pneumothorax, making patients become haemodynamically unstable...

DON’T LOOK at Q pic until looked at A side of FC

Answer 13

Question 14

Tension pneumothorax
- Give specific reasons why patients become haemodynamic unstable

Answer 14

CO = SV x HR
Therefore, one of the ways the heart compensates for decreased preload is through increasing heart rate LEADS TO TACHYCARDIA

Question 15

Summary of Tension Pneumothorax pathophysiology (specficially)

Answer 15

Question 16

Tension pneumothorax:

• Signs and Symptoms
• Signs of decompensation

Answer 16

Question 17

Tension Pneumothorax
- Radiology

Answer 17

Question 18

Emergency Needle Decompression - Tension pneumothorax
- How to do this

Answer 18

Question 19

GW:

• What is transpulmonary pressure
• X-ray of a pnuemothorax
• Stab injury to the rest chest, in the 7th right intercostal space in the mid axillary line - name the structures the knife would have to go through to enter the pleural cavity

pic attached - AP xray, can see scapula

Answer 19

Transpulmonary pressure:
The pressure difference between the pressure inside the lung and intrapleural pressure

Pic - xray

Skin, subcutaneous fat, serratus anterior muscle, intercostal muscles (3), parietal pleura

Question 20

GW:

• Interpret the ABG attached to this FC. It is from a man who has COPD and left lung atelactasis secondary to a pneumothorax
• Percusion over pneumothorax…
• Lung auscultation demonstrated stony dullness?
• How can sepsis lead to metabolic acidosis?
• How can liver cirrhosis lead to pleural effusion?

Answer 20

• pic
• Percusion over pneumothorax…
  air -
  Hyper-resonant (loud and lower pitch), as more air, like a drum
• Stony dullness - Pleural effusion
• Sepsis -> hypoperfusion -> anaerobic respiration -> lactic acid
• transudate material (low protein), due to liver cirhosis and portal hypertension