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Respiratory > Session 6 > Flashcards

Session 6 Flashcards

1
Q

What is a pneumothorax

A

Presence of air in the pleural space

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2
Q

Why does air enter the pleural space

A

-Pleura have a hole
-Intrapleural pressure is lower than atmospheric pressure
-Air moves from an area of high to low pressure
-Pleural seal is broken
-Lungs disconnected from chest wall and collapse due to inward elastic recoil

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3
Q

When does primary spontaneous pneumothorax occur

A

Usually young, tall, thin males
Rupture of an underlying sub pleural blew or bulla can be responsible

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4
Q

What are blebs and bullas

A

Bleb = small thin walled air containing spaces

Bulla = permanent, air filled space at least 1cm

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5
Q

How does bleb or bulla rupture cause pneumothorax

A

Creates an opening on visceral pleura
Consequent loss of negative intrapleural pressure
Loss of seal
Partial or complete lung collapse

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6
Q

Smoking and pneumothorax

A

Increases risk of primary spontaneous pneumothorax by 10-20 fold

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7
Q

Secondary spontaneous pneumothorax causes

A

COPD, CF, lung malignancy or asthma

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8
Q

Traumatic pneumothorax cause

A

Iatrogenic- invasive medical procedures e.g. central vein cannulation, pleural tap or biopsy, transbronchial biopsy, fine needle aspiration

Accidental = penetrating chest injury lacerating parietal pleura and/or visceral pleura, laceration due to fractures rib

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9
Q

What is a tension pneumothorax

A

Can occur due to any aetiology and is defined as any size of pneumothorax causing mediastinal shift and cardiovascular collapse

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10
Q

How does a tension pneumothorax develop

A

Due to a one-way valve system at site of breach in pleural membrane

Air enters pleural cavity during inspiration but doesn’t leave during expiration

Increase in intrapleural pressure that exceeds atmospheric pressure for much of respiratory cycle

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11
Q

Result of tension pneumothorax

A

Impaired gas exchange from loss of lung volume

Impaired venous return and reduced cardiac output

Typical features of hypoxaemia and haemodynamic Compromise

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12
Q

How does mediastinal shift occur

A

Tension pneumothorax

Mediastinum shifts towards Contralateral side

Impinges on and compresses Contralateral lung

impairs cardiac venous return

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13
Q

Why does pneumothorax cause impaired cardiac venous return

A

Veins of the body rely on low intrathoracic pressure to return blood to the heart

Course of the veins returning to heart is distorted due to mediastinal shift

Decreased preload and decreased cardiac output = decreased blood pressure (unless compensatory mechanisms)

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14
Q

Reason for tachycardia in tension pneumothorax

A

Cardiac output = Stroke volume x HR

Increased intrathoracic pressure and hypoxaemia may directly impact heart

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15
Q

What do to when tension pneumothorax is suspected

A

Immediate decompression of thorax - not delayed for radiographer confirmation

Needle thoracocentesis: wide bore cannula into second intercostal space mid clavicular line (2ICS MCL), just above the third rib

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16
Q

Clinical features and radiology of pneumothorax

A

Sudden onset of pleuritic chest pain and dyspnea

Reduced chest movements and breath sounds on affected side,

percussion hyper resonant on affected side, vocal resonance reduced

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17
Q

Clinical features that suggest tension pneumothorax

A

Severe respiratory distress, tachypnoea, tracheal shift, elevated JVP, tachycardia, hypotension

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18
Q

By what route is the air getting into the pleural space when a visceral bleb bursts (as in primary spontaneous pneumothorax)

A

Air enters through lung parenchyma across visceral pleura and into space during inspiration

Pleural seal broken, part or all of lung collapses

Not a one way valve as each expiration of air can get out of pleural space

19
Q

What maintains pleural fluid

A

Secreted by parietal pleura and drained through lymphatics of parietal pleura

Balance of hydrostatic and oncotic pressures and lymphatic drainage

20
Q

Purpose of pleural fluid

A

Maintains pleural seal that keeps visceral and parietal pleura connected

Lubricant to facilitate sliding motion of both pleural surfaces during inspiration and expiration

21
Q

Pleural effusions may result from

A

Disruption of the balance between hydrostatic and oncotic pressures, or disrupted lymphatic drainage

22
Q

What is pleural effusion

A

Collection of extra fluid in the pleural space

23
Q

Types of pleural effusion

A

Blood = haemothorax
Chyle = chylothorax (lymph)
Pus = empyema

24
Q

Characterisation of effusions

A

Removal and analysis of fluid = diagnostic pleural aspiration

Simple effusions= transudates or exudates

25
Q

Visual inspection of pleural fluid

A

Bloody and chylous?
Purulent (suggestive of empyema)?
Viscous (suggestive of mesothelioma)?

26
Q

Fluid should always be sent for

A

Total protein, LDH, cell count and cell differential, gram stain, aerobic and anaerobic bacterial cultures

Others = glucose, cytology, TB fluid markers etc

27
Q

Pleural aspiration and drainage is

A

Diagnostic and therapeutic (to remove XS to assist respiration and provide symptomatic relief)

28
Q

Common causes of transudative pleural effusions

A

Increased pleural capillary hydrostatic pressure- congestive heart failure

Decreased capillary oncotic pressure- low serum albumin, cirrhosis, nephrotic syndrome

29
Q

Common causes of exudative pleural effusions

A

Due to increased capillary permeability (inflammation, malignancy)

  1. Bronchial carcinoma
  2. Pneumonia
  3. TB
  4. Pulmonary infarction from pulmonary embolism
  5. Metastasis (lung one of most common sites of metastasis, especially for bladder, colon, breast, prostate, germ cell tumours and head and neck squamous carcinomas)
30
Q

Chest X ray in someone with pleural effusion due to congestive heart failure

A

Enlarged heart

31
Q

What are parapnemonic effusions

A

Effusions caused by an underlying pneumonia

Complicated parapneumonic infection = spread to pleural space

32
Q

3 types of effusion associated with pneumonia

A

Simple parapneumonic —>

complicated parapneumonic effusion—>

Empyema

33
Q

Causes of empyema

A

Pneumonia
Penetrating trauma (iatrogenic, oesophageal rupture)

34
Q

Radiography of empyema

A

Opacification of hemithorax

35
Q

Simple spontaneous primary/secondary pneumothorax sequence of events

A

Small tear in visceral pleura
Air leaks into pleural space when breathing in
Pleura seals itself
Air in pleural space will be reabsorbed

36
Q

Needle aspirations of up to

A

2.5 L

37
Q

Treatments for simple pneumothorax

A

Needle aspiration of up to 2.5L
High flow oxygen and observe for 24 hrs
May need chest drain

38
Q

Key difference in monitoring of secondary simple pneumothorax

A

Seal less stable

39
Q

How does needle aspiration work

A

Small amount of water in syringe
Push through chest wall until air bubbles

40
Q

Borders of anatomical safe triangle

A
41
Q

Why do we give oxygen therapy

A

High flow oxygen even if sats normal
High conc in pleural space
reabsorbed faster than nitrogen

42
Q

Fluid analysis for pleural effusions

A
43
Q

Disorders which pre dispose someone to simple spontaneous primary pneumothorax

A

Marfans syndrome
Ehlers-danlos

Respiratory (7 decks)

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