Pneumothorax Flashcards
Pneumothorax : Definition
presence of air within the pleural cavity from a defect on the lung surface
Pneumothorax : Physiology
- Parietal pleura is stuck onto the chest wall - which expands the chest cavity outwards
- Visceral pleural is stuck onto the lungs - elastic recoil pulls the lung inwards
- Opposing forces therefore creates ; negative pressure within the pleural space
Pneumothorax : Pathophysiology
- Trauma to the pleura - creates an opening in which air moves into the pleural space
- Negative pleural pressure is lost - thus there is no vacuum to hold the opposing forces together
- Lungs pull inwards and collapse
- Chest wall springs outwards
Pneumothorax : Spontaneous pneumothorax - Pathophysiology
Normally occurs due to -
- Damage to the alveoli creates a tiny leak and an air pocket forms called a bullae
- The bullae bursts and creates a large whole in the visceral pleura and enters the pleural space
Pneumothorax : Primary spontaneous pneumothorax
- Absence of any underlying lung conditions
- Typically : Thin, tall adolescent male - hx of high internal pressure due to holding his breath etc
Pneumothorax : Secondary sponatenous pneumothorax
- Pneumothorax that occurs with a patient with underlying lung disease
Such as hx of : Marian’s, CF, emphysema, etc
Pneumothorax : Traumatic pneumothorax
Pneumothorax develops due to damage to the pleura secondary to trauma such as stab wound etc.
Pneumothorax : Tension Pneumothorax
- Damage to pleura creates a one - way valve
- Air in able to enter into the pleural space but not leave
- Thus pleural pressure begins to increase and inflate
Increased pressure in mediastinum - Cardiorespiratory arrest
Tension Pneumothorax : Clinically features
- Hypoxic
- Tachycardia, and Hypotensive
- Distended neck veins
- Tracheal deviation away from the affected side.
Tension Pneumothorax : Management
1 . High flow oxygen
2 . Needle decompression
Large bore cannula inserted into the pleural cavity at
* 2nd intercostal space mid-clavicular line or 5th intercostal space mid-axillary line.
* Hiss confirms diagnosis
3 . Chest drain inserted
Pneumothorax : Clinical features
Sharp sudden chest pain - Pleuritic in nature
Dyspnea
Tachypnea - 2nd to reduced lung function
Dry, non productive cough
Pneumothorax : Clinical signs
- Reduced chest sounds due to lung collapse
- Hyper-resonance on chest percussion
- Reduced chest expansion
- Deviation of the trachea
Pneumothorax : CXR
CXR - determine size of the pneumothorax
Measure interpleural distance at the level of the hilum
Pneumothorax : Mx of assymptomatic patient
1 . Assess if patient is symptomatic
no significant pain or breathlessness and no physiological compromise
2 . No symptoms —> Conservative management
3 . Conservative management
1 . _Primary Spontaneous Pneumothorax_
* review every 2-4 days OP
2 . Secondary Spontaneous Pneumothorax
* Admit for inpatient monitoring
Pneumothorax : Mx of symptomatic patient
**1. Assess if patient is symptomatic
no significant pain or breathlessness and no physiological compromise
__Symptomatic patient__
1. Assess for high-risk characteristics
* Haemodynamic compromise - ?tension pneumothorax
* Haemothorax
* Bilateral Pneumothorax
* Underlying lung disease
* >50 years AND significant smoking history
2 . Is Pneumothorax a sufficient size
* >2cm laterally or Apically
No —> CT and reassess
Yes —> Consider next intervention
. _ High Risk characteristic present + AND Sufficient size _
* Chest drain
No High RISK characteristic + AND Sufficient size for intervention
- What is the patient’s main priority?
1 . Procedure avoidance —> Conservative mx
2 . Rapid symptomatic relief
* —> Ambulatory device + r/v every 2-3 days OP
- ——>Needle Aspiration —>
i). unresolved —> admit for Chest drain
ii). Resolved —> Discharge
