Sketchy Path: Pneumothorax

Question 1

Review the symptoms of pneumothorax.

Answer 1

• Dyspnea (girl crouching in back)
• Hyperresonance over collapsed lung (drummer beating drum)
• Sharp, pleuritic chest pain (sharp necklace on drummer0
• Distant lung sounds (distant lung sails behind sailboat)

Question 2

Which population is most at risk of spontaneous pneumothorax?

Answer 2

Young, tall, thin males who smoke (like the young guy being stretched until his shirt pops next to the torturer with the cigar)

Question 3

The most common cause of secondary pneumothorax is __________.

Answer 3

COPD (like the blue-bloater iron maiden crushing the pink-puffer fish)

Question 4

Other than COPD, list some causes of secondary pneumothorax.

Answer 4

• Cancer (crabs in the iron maiden)
• TB (cactus in the iron maiden)
• Pneumonia (knight with rusty chest plate in iron maiden)
• Trauma (like the blunt club, the rib cage over the man in the chair, and the neck shackle –neck injury can also cause pneumothorax)

Question 5

Pneumothoraces less than ________ percent of the lung field can usually be treated with O2 and observation.

Answer 5

50

Question 6

The main pathology in tension pneumothorax is ____________.

Answer 6

a wound with a one-way flap of tissue that allows air in but not out (like the flap in the sail)

Question 7

In a tension pneumothorax, the mediastinum ____________.

Answer 7

shifts to the opposite side (like the sail mast breaking opposite the sail hole)

Question 8

Tension pneumothorax presents with what other set of signs?

Answer 8

Heart failure signs from compression of the mediastinum –JVD, tachycardia (like the jug and elevated heart clock near the punctured sail)

Question 9

What is the treatment for tension pneumothorax?

Answer 9

Insert a 14-16 gauge needle in the second intercostal space, midclavicular line

Question 10

How do you differentiate hemothorax from bloody pleural effusion?

Answer 10

Clots will be found in the hemothorax (like the ice cubes in the bloody drink)

Question 11

Hemothoraces are usually caused by ______________.

Answer 11

ruptured intrathoracic aneurysm

Question 12

Chylothorax can be caused by what two things?

Answer 12

• Surgery

* Lymphoma occluding the thoracic duct (crab on plate)

Question 13

Hemothorax and chylothorax present with what physical exam finding that is different from pneumothorax?

Answer 13

Dullness to percussion (like the feet resting dully on the drum beneath the hemothorax table)