session 10- pneumothorax and pleural effusion

Question 1

what is pneumothorax

Answer 1

air within the pleural cavity

Question 2

what is a simple pneumothorax

Answer 2

tiny rim of air in pleural cavity, patient is haemodynamically stable

Question 3

what is a tension pneumothorax

Answer 3

one way flow of air into pleural cavity causes haemodynamic instability

Question 4

risk factors primary pneumothorax

Answer 4

male, young, family history, smoking

Question 5

diseases causing secondary pneumothorax

Answer 5

COPD, asthma, bronchiectasis, lung cancer, TB, pneumonia, marfans, ehlers danlos, ra

Question 6

what causes spontaneous pneumothorax

Answer 6

subpleural bleps/bulla (air filled sacs)

Question 7

what causes iatrogenic pneumothorax

Answer 7

insertion of central lines/pacing

Question 8

what causes trauma pneumothorax

Answer 8

• severe chest wall injury such as stab wound causing air entry into pleural space
• rib fractures puncture visceral pleura

Question 9

symptoms simple pneumothorax

Answer 9

pleuritic pain, sudden onset, sharp pain. SOB, history of trauma/lung disease

Question 10

signs simple pneumothorax

Answer 10

no trachea deviation, reduced chest movement, hyper-resonant percussion, reduced/absent auscultation, reduced vocal/tactile response

Question 11

CXR simple pneumothorax

Answer 11

hyper-lucent, absent lung markings, collapsed lung borders seen

Question 12

CT simple pneumothorax

Answer 12

absent lung markings, collapsed lung borders seen

Question 13

3 treatment options pneumothorax

Answer 13

conservative treatment, pleural aspiration, chest drain

Question 14

describe the safe triangle for chest drain placement

Answer 14

superior- base axilla
inferior- 6th rib
anterior- lateral edge pec major
posterior- lateral edge latissimus dorsi

Question 15

symptoms tension pneumothorax

Answer 15

sudden onset pleuritic chest pain, sharp. SOB, trauma history. anxiety
ALSO- respiratory distress, cyanosis, tachycardia, hypoxemia

Question 16

which 4 symptoms distinguish tension from simple pneumothorax

Answer 16

respiratory distress, cyanosis, tachycardia, hypoxemia

Question 17

signs tension pneumothorax

Answer 17

absent breath sounds, hyper-resonance, cardiac apical displacement, asymmetric lung expansion, hypotension, increased jugular venous distension, tachycardia/tachypnoea

Question 18

where to insert needle for decompression

Answer 18

2nd intercostal space, mid-clavicular line

Question 19

what is a tension pneumothorax

Answer 19

air enters and accumulates in pleural space as air cannot leave through opening-flap of tissue creates one way valve. intrapleural pressure constantly increasing

Question 20

CXR tension pneumothorax

Answer 20

absent lung markings, depression diaphragm affected side, hyper lucency, lung edge visible, mediastinal shift away from affected lung, ribs more horizontal and overexpanded on affected side, trachea shifted away from affected lung

Question 21

how does tension pneumothorax affect the heart

Answer 21

hypoxia, direct pressure, decreased venous return

increased pressure causes mediastinal shift which compresses lung, causing hypoxia. this increased pressure compresses SVC and kinks IVC, reducing venous return to RA. this reduces cardiac function.

Question 22

3 effects of tension pneumothorax if not treated

Answer 22

respiratory insufficiency, cardiovascular collapse, death

Question 23

what is pleural effusion

Answer 23

fluid in pleural cavity

Question 24

simple effusion cause

Answer 24

pleural fluid- transudate/exudate

Question 25

haemothorax cause

Answer 25

blood

Question 26

chylothorax cause

Answer 26

lymph

Question 27

empyema cause

Answer 27

pus

Question 28

symptoms pleural effusion

Answer 28

gradual onset SOB, pleuritic chest pain, features of underlying clinical disease such as congestive cardiac failure/lung malignancy

Question 29

signs pleural effusion

Answer 29

trachea deviation, reduced chest movement, stony percussion, reduced breath sounds, reduced vocal resonance

Question 30

CXR pleural effusion

Answer 30

meniscus

Question 31

investigations pleural effusion

Answer 31

pleural aspiration. send fluid for protein, glucose, LDH, levels and pH and MC&S

Question 32

transudate vs exudate

Answer 32

transudate has less protein and LDH.

Question 33

cause transudate simple effusion

Answer 33

congestive cardiac failure, hypoprotinaemia

Question 34

cause exudate simple effusion

Answer 34

infection, lung malignancy, pulmonary infarction

Question 35

transudate vs exudate

Answer 35

transudate caused by changes in hydrostatic/oncotic pressure. exudate is caused by inflammation causing tissue leakage/leaky capillaries. this is why exudate has more proteins and LDH and is caused by infections.

Question 36

treatment pleural effusion

Answer 36

chest aspiration

chronic

• indwelling pleural catheter
• pleurdesis (obliteration of pleural space)