session 10- pneumothorax and pleural effusion Flashcards
what is pneumothorax
air within the pleural cavity
what is a simple pneumothorax
tiny rim of air in pleural cavity, patient is haemodynamically stable
what is a tension pneumothorax
one way flow of air into pleural cavity causes haemodynamic instability
risk factors primary pneumothorax
male, young, family history, smoking
diseases causing secondary pneumothorax
COPD, asthma, bronchiectasis, lung cancer, TB, pneumonia, marfans, ehlers danlos, ra
what causes spontaneous pneumothorax
subpleural bleps/bulla (air filled sacs)
what causes iatrogenic pneumothorax
insertion of central lines/pacing
what causes trauma pneumothorax
- severe chest wall injury such as stab wound causing air entry into pleural space
- rib fractures puncture visceral pleura
symptoms simple pneumothorax
pleuritic pain, sudden onset, sharp pain. SOB, history of trauma/lung disease
signs simple pneumothorax
no trachea deviation, reduced chest movement, hyper-resonant percussion, reduced/absent auscultation, reduced vocal/tactile response
CXR simple pneumothorax
hyper-lucent, absent lung markings, collapsed lung borders seen
CT simple pneumothorax
absent lung markings, collapsed lung borders seen
3 treatment options pneumothorax
conservative treatment, pleural aspiration, chest drain
describe the safe triangle for chest drain placement
superior- base axilla
inferior- 6th rib
anterior- lateral edge pec major
posterior- lateral edge latissimus dorsi
symptoms tension pneumothorax
sudden onset pleuritic chest pain, sharp. SOB, trauma history. anxiety
ALSO- respiratory distress, cyanosis, tachycardia, hypoxemia
which 4 symptoms distinguish tension from simple pneumothorax
respiratory distress, cyanosis, tachycardia, hypoxemia
signs tension pneumothorax
absent breath sounds, hyper-resonance, cardiac apical displacement, asymmetric lung expansion, hypotension, increased jugular venous distension, tachycardia/tachypnoea
where to insert needle for decompression
2nd intercostal space, mid-clavicular line
what is a tension pneumothorax
air enters and accumulates in pleural space as air cannot leave through opening-flap of tissue creates one way valve. intrapleural pressure constantly increasing
CXR tension pneumothorax
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
how does tension pneumothorax affect the heart
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.
3 effects of tension pneumothorax if not treated
respiratory insufficiency, cardiovascular collapse, death
what is pleural effusion
fluid in pleural cavity
simple effusion cause
pleural fluid- transudate/exudate
haemothorax cause
blood
chylothorax cause
lymph
empyema cause
pus
symptoms pleural effusion
gradual onset SOB, pleuritic chest pain, features of underlying clinical disease such as congestive cardiac failure/lung malignancy
signs pleural effusion
trachea deviation, reduced chest movement, stony percussion, reduced breath sounds, reduced vocal resonance
CXR pleural effusion
meniscus
investigations pleural effusion
pleural aspiration. send fluid for protein, glucose, LDH, levels and pH and MC&S
transudate vs exudate
transudate has less protein and LDH.
cause transudate simple effusion
congestive cardiac failure, hypoprotinaemia
cause exudate simple effusion
infection, lung malignancy, pulmonary infarction
transudate vs exudate
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.
treatment pleural effusion
chest aspiration
chronic
- indwelling pleural catheter
- pleurdesis (obliteration of pleural space)
