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Flashcards in 3 - pneumothorax Deck (19)
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1
Q

definition of pneumothorax

A

accumulation of air in pleural space: secondary lung collapse

2
Q

etiology of pneumothorax: 4?

A

rupture of visceral pleura with secondary air leak from lung. rupture of trachea/bronchus. rupture of esophagus. loss of integrity of chest wall.

3
Q

classification of pneumothorax.

A

spontaneous (can be primary or secondary). traumatic. iatrogenic

4
Q

physiology of pneumothorax

A

pressure is more negative at top than at base of lung. if air enters pleural cavity, lung collapses = decrease compliance = decrease FRC = decrease ventilation = decrease oxygenation

5
Q

tension pneumothorax: severity? what happens?

A

life threatening. one way flow of air due to ball valve = progressive increase in pressure within pleural space = shifts mediastinum, can decrease venous return to heart = obstructive shock.

6
Q

clinical symptoms and signs of pneumothorax

A

sudden chest pain and shortness of breath. tachynpea, tachycardia. hypotension. elevated JVP. decreased breath sounds. hyper resonance. tracheal deviation.

7
Q

histopathology: blebs? bullae?

A

blebs = small, subpleural collection of air resulting from ruptured alveoli. bullae = large air filled spaces within lung associated with any form of emphysema (like a collection of blebs)

8
Q

primary spontaneous pneumothorax: caused by? seen in who? recurrence? % tension?

A

rupture of subpleural blebs. in young, tall pts, males > females. recurrence 25% after 1, 50% after 2, 80% after 3. 5% are tension pneumos.

9
Q

how to diagnose PSP

A

with symptoms and signs, and do an x ray: PA film with inspiratory AND expiratory views (because expiratory view can help accentuate)

10
Q

how to manage PSP?

A

in a select few can observe. mostly will do a tube thoracostomy. might consider chemical pleurodesis or surgical management.

11
Q

chemical pleurodesis: what? when to do?

A

induces pleural fibrosis and adhesions. only if pt refuses surgery or is high risk

12
Q

when to do surgery for PSP?

A

first episode if: prolonged airleak, non re expansion, bilateral, tension, hemopheumothorax, occupational hazard, absence of facilities. will do it for a second episode for sure

13
Q

what happens during surgery for a PSP?

A

resect blebs, then obliterate pleural space: can do an apical pleurectomy, or pleural abrasion (creates scar tissue = less likely to get tension pneumo if you get a another pneumothorax)

14
Q

secondary sponatneous pneumothorax: in who? mortality?

A

in older patients with underlying pulmonary disease: like diffuse emphysema, bullous disease. higher mortality

15
Q

most common cause of SSP? what happens? management?

A

COPD: rupture of bulla. usually with chest tube. might do surgery depending on comorbidity, more common to do chemical pleurodesis

16
Q

catemenial pneumothorax: associated with? pathophysl?

A

menstruation. usually small pneumothoraxes: air reaches chest from cervix via diaphragm, or from pleural endometrial implants

17
Q

treatment of catemenial pneumothorax

A

conservative, might do surgery. maybe hormonal manipulation

18
Q

needle thoracostomy: what? where? what to always do after?

A

urgent decompression of pneumothorax: 16-18G needle in 2nd intercostal space, mid clavicular line. always follow with chest tube.

19
Q

tube thoracostomy: where?

A

mid axillary line in line with nipple