TPT Signoff Flashcards
Definition of pneumothorax
The presence of air between the visceral and parietal pleura causing compression and displacement of the lung.
Definition of tension pneumothorax
A life threatening accumulation of air in the pleural space secondary to damage to the visceral or parietal pleura, which creates a one-way valve. This causes lung collapse on the affected side and compression of heart and major vessels.
Patho of simple pneumothorax
- non-expanding collection of air in the pleural cavity
- does not require decompression if not compromising oxygenation
Patho of spontaneous pneumothorax
- spontaneous rupture of a bleb allows air to enter the pleural space
- Primary: occurs in healthy individuals with no associated trauma
- Secondary: occurs in pts with lung disease
Patho of tension pneumothorax
- air enter pleural space through a tissue flap/hole in visceral or parietal pleura
- hole acts as a one way valve allowing air to enter on inspiration but becomes trapped on expiration
- causes increased pressure in pleural space and loss of negative pressure hence causing the lung to collapse
- as pressure increases with mediastinal shift, major vessels are compromised
- decreased VR from IVC and SVC causes reduced CO
Patho of Iatrogenic pneumothorax
- develops secondary to medical intervention which allows air into pleural space
- caused by cardiac compressions and IPPV
Patho of open pneumothorax
- occurs with injury to chest wall allowing air to move freely between atmosphere and pleural space
- if injury is larger than normal airway pathway, air will travel through the wound during inspiration rather than the trachea
- air moves into pleural space during inspiration and our the wound on expiration causing a sucking chest wound
Hard signs of TPT
- decreased conscious state
- decreased BP
- stiff bag
Soft signs of TPT
- unequal breath sounds
- resp distress or worsening distress in setting of chest trauma
- poor perfusion
- subcutaneous emphysema
- tracheal shift
- low spo2
- increased JVP
Treatment of TPT - who to stab
- deteriorating conscious state and decreasing BP
- deteriorating conscious state and progressive resp distress in trauma
- stiff bag on attempted PPV
Treating trauma pt
-pt with mechanism of injury who is deteriorating, bilateral decompression
Treating asthmatic pt
-allow 1min apnoea before attempting decompression
Perform unilateral chest decompression if:
location of the TPT is obvious
Perform bilateral decompression if:
- pt presents in immediate life threat
- injury may have involved both sides
- unclear which side injury has occurred
- always decompress right side first
Insertion site for decompression
Second intercostal space Midclavicular line Above the rib below Right angles to chest Towards the spine
