6. Pneumothorax Flashcards
(25 cards)
classify primary and secondary pneumothorax
primary- no underlying oathology, due to future of sub pleural air bleb
secondary- there is e.g. COPD, asthma, pulmonary fibrosis
aetiology of simple spontaneous primary pneumothorax
- small tear in visceral pleura
- air leaks into pleural space when breathing in
- pleura seals itself due to elastic recoil
- air in pleural space reabsorbed
AIR MOVES IN AND OUT SO REACHES EQUILIBRIUM OF PRESSURES
treatment of pneumothorax with no breathlessness, <2cm
nothing, discharge and follow up in 2/3 weeks with CXR
aetiology of simple spontaneous secondary pneumothorax
- underlying lung pathology punctures pleura e.g. bleb/bullae rupture
- less elastic recoil so more air in pleural space
- puncture seals itself eventually once pressures equilibrate
treatment of spontaneous simple secondary pneumothorax
-needle aspiration up to 2.5 L
-high flow O2 and observe 24 hours
(aim for 88-92% if they’re a COPD retainer)
-chest drain maybe is seal reopens
describe how a needle aspiration works
small amount of water in syringe, push through chest wall until air bubbles
NEED A VALVE or water will enter pleural space
borders of anatomical safe triangle
superior: axilla
medial: pec major lateral edge
lateral: lat dorsi lateral edge
inferior: 5th ICS
treatment of simple iatrogenic pneumothorax
chest drain
describe how a water sealed chest drain works
insert into safe triangle, tube in pleural cavity
free end submerged in water
=one way valve
swinging (pressure changing) and bubbling (air leaving) means its working
how do you know a chest drain is working?
swinging (pressure changing) and bubbling (air leaving) means its working
in tension pneumothorax, why might the chest dip on inspiration?
paradoxical breathing- occurs when multiple ribs fractured
do you CXR in suspected tension pneumothorax?
NO
patient would be dead before you could treat
emergency needle decompression
how does a tension pneumothorax develop?
damaged pleura creates a one way valve, air in but NOT out
increased intra thoracic pressure
each breath fills pleural space more, so no eqm can be reached
compresses mediastinal structures,= haemodynamic compromise as heart can’t pump
immediate treatment of tension pneumothorax
emergency needle decompression
where to do emergency needle decompression
2nd ICS mid clavicular line
possible signs of pneumothorax
reduced breath sounds
hypoxia
hyper resonance
flail segment
surgical emphysema
possible symptoms of pneumothorax
pleuritic chest pain
SOB
sudden acute onset
types of pleural effusion
haemothorax: blood
chylorthorax: lymph
empyema: pus
bunting of costophrenic angle
pleural effusion
contrast the types of fluid in pleural effusion
transudate:
-low protein
-low LDH
-caused by hypoalbimunaemia (e.g cirrhosis), CHF
exudate:
-high protein
-high LDH
-caused by autoimmune, malignancy, pancreatitis, infection, oesophageal rupture, PE
common and less common causes of transudative pleural effusion
common
-HF
-cirrhosis
less common
-hypoalbuminaemia
-nephrotic syndrome
-hypothyroidism
common and less common causes of exudative pleural effusion
common
-infection e.g. TB
-malignancy
less common
-pulmonary infarction
-autoimmune e.g. rheumatoid
-pancreatitis
-post MI
-post CABG
what causes fluid accumulation in transudative pleural effusion
disruption in hydrostatic and oncotic pressures
what causes fluid accumulation in exudative pleural effusion
increased pleural and capillary permeability
