Week 9 Resp Flashcards
Types of Pneumothorax
Spontaneous
Primary (PSP): no underlying lung disease
Secondary (SSP): underlying lung disease eg COPD or malignancy
Traumatic
Latrogenic: complication of a medical procedure
Penetrating trauma:
Risk Factors of Pneumothorax
PSP: most common 15-34
SSP: most common over 50
3-6x more likely for males
Risk factors: smoking, fam history, sub plueural blebs, underlying lung disease
Presenting symptoms and differentials for pneumothorax
Symptoms
Acute onset Dyspnoea
Chest pain (often pleuritic)
NB: intensity varies very much/ young may be very little pain
Differentials
PE, Pleuritis,MI, pericarditis, Musculoskeltal inflammation
Clinical Sings of Pneumothroax
Inspection: Chest wall trauma, work of breathing, use of accessory ,muscles
Trachea: sometimes deviated to opposite side
Chest expansion reduced on same (ipsilateral) side
Percussion: hyper-resonant
Auscultation: reduced or absent breath sounds
Pneumothroax investigations:
Blood tests:
- Inflammatory markers (WCC and CRP)
- Troponins (to check for MI)
- D-Dimer (shows PE)
ECG:
- Rule out MI and pericarditis
CXR:
- main tool
- Check for abscences f lung markings, visceral pleural line
- Tracheal deviation
CT
Tension Pneumothorax
One way valve effects results in intrapleural pressure, resulting in mediastinal shift, collapse of great vessels and ventricle —> cardiopulmonary compromise
Signs and symptoms:
-Dyspnoea, chest pain, tachypnoea, tachycardia, hypoxaemia, progressive hypertension, signs of pneumothorax )decreased BS and hyper res)
Managment of Tension Pneumothorax
Needs urgent decompression
Needle decompression in 2nd ICS mid claviclular
Or tube thortacosotmy
management for a small, asymptomatic primary spontaneous pneumothorax?
Observation and oxygen therapy. Small pneumothoraces may resolve on their own with supplemental oxygen to help reabsorption.
treatment for a large or symptomatic primary spontaneous pneumothorax
Needle aspiration or chest tube insertion to remove air from the pleural space and allow lung re-expansion.
When is surgical intervention considered for primary spontaneous pneumothorax
Surgical options, such as video-assisted thoracoscopic surgery (VATS), are considered after recurrent episodes or persistent air leaks despite chest tube drainage.
What is pleurodesis and when is it used
Pleurodesis is a procedure that causes the pleural layers to adhere, preventing future pneumothorax. It’s used after recurrent spontaneous pneumothorax or in patients with high risk of recurrence.
Talc, doxycycline, and sterile betadine are common agents used to induce pleural adhesion in pleurodesis
What factors increase the risk of recurrence of a pneumothorax
Smoking, underlying lung disease (e.g., COPD), and prior pneumothorax increase the risk of recurrence, making preventive strategies like pleurodesis more important.
Three mechanisms for fluid in pleural space (broad)
- Abnormal hydrostatic or osmotic forces (transudate)
Eg: increases hydrostatic due to fluid overload during HF - Increased permeability (exudate)
Eg: usually due to neoplasm or inflamation - Disruption of the fluid continuing structure within the pleural cavity
Eg: Blood vessels, oesophagus, thoracic duct
Common causes of Pleural effusion
Heart Faiure, malignancy, infection, post surgical, pericardial disease, liver cirrhosis
More common in adults
25% are idiopathic
Symptoms of Pleural effusion and signs
Symptoms
Dyspnoea (due to increased weight on diaphragm and increased work of breathing)
Cough
Chest pain (usually pluertic)
Signs
Clubbing
tar staining
Enlarged lymph nodes
Chest wall scares
Raised JVP
Maybe deviated trachea to opposite side
Reduced chest expansion
Stony dull percussion
Reduced or absent breath sounds
Investigations for pleural effusions
CXR, Thoracic ultrasound, CT scan
Also things to rule out others such as
WCC and CRP
Troponin
D-Dimer
ECG
